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modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SEROQUEL 25MG","drug_information":{"unit":25.0,"type":"ME"},"code_information":[{"code":"4401535","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"165717171","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":9.38,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SEROQUEL 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modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SINEMET 25-250","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"4401548","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"2282545","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"NDC EA = 1 TAB | The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SINEMET 50-200 CR 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does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SKELAXIN 800MG","drug_information":{"unit":8.0,"type":"ME"},"code_information":[{"code":"4401553","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"52714351","type":"NDC"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":25.5,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"CLINDAMYCIN 600MG 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meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"CONC NACL 4MEQ/ML","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"4401561","type":"CDM"},{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323933","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"NDC EA = 12 MEQ"}]},{"description":"SOD POLYSTYRENE 120M","code_information":[{"code":"4401562","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.5,"discounted_cash":88.25,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SORBITOL 70%","drug_information":{"unit":3.0,"type":"ML"},"code_information":[{"code":"4401564","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"4628753","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":8.12,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SPIRIVA 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APP | The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SSD 1% 50GM","code_information":[{"code":"4401568","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":34.5,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SSD 1% 400GM","code_information":[{"code":"4401569","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.25,"discounted_cash":70.12,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"STARLIX 60MG","drug_information":{"unit":6.0,"type":"ME"},"code_information":[{"code":"4401571","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"498849841","type":"NDC"}],"standard_charges":[{"gross_charge":17.25,"discounted_cash":8.62,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"BENZTROPINE 1MG TAB","code_information":[{"code":"4401572","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SMX/TMP 200/40 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presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"AMANTADINE 100MG","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"4401578","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"447752","type":"NDC"}],"standard_charges":[{"gross_charge":10.5,"discounted_cash":5.25,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"SYNTHROID 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modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"LEVOTHYROX 100MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"4401582","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"37818977","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":3.38,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"NDC EA = 1 MCG | The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"LEVOTHYROX 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MCG | The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"LEVOTHYROX 125MCG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"4401585","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"378181377","type":"NDC"}],"standard_charges":[{"gross_charge":6.75,"discounted_cash":3.38,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"NDC EA = 125 MCG | The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"GUAIFEN/COD 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presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"RANEXA 500MG TABLET","drug_information":{"unit":5.0,"type":"ME"},"code_information":[{"code":"4401589","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"61958131","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":16.5,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"HYDROMORPHONE 2MG 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is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"TOLNAFTATE 1% POWDER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"4401595","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"536132926","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"NDC EA = 1 APP | The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"TEGRETOL XR 100MG","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"4401597","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"78515","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"TEMAZEPAM 15MG","drug_information":{"unit":15.0,"type":"ME"},"code_information":[{"code":"4401598","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"441461","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"GUANFACINE 1MG","drug_information":{"unit":1.0,"type":"ME"},"code_information":[{"code":"4401600","type":"CDM"},{"code":"250","type":"RC"},{"code":"A9270","type":"HCPCS"},{"code":"24658731","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","modifier_code":["GY"],"billing_class":"facility","additional_generic_notes":"The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"BENZONATATE 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schedule","standard_charge_dollar":24.22}]}]},{"description":"Oocyte identification","code_information":[{"code":"89254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.22,"maximum":151.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148.5,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":151.47,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24.22}]}]},{"description":"Culture bacterial urine","code_information":[{"code":"P7001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.72,"maximum":7.72,"payers_information":[{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7.72}]}]},{"description":"Pathogen test for platelets","code_information":[{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.71,"maximum":52.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51.42,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52.45,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10.71}]}]},{"description":"Obtaining screen pap smear","code_information":[{"code":"Q0091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.85,"maximum":25.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25.72,"additional_payer_notes":"APC"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3.85}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16446.62,"maximum":21325.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":16446.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16775.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16775.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16446.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16446.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16446.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18812.8},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16446.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16446.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16446.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures With Mcc","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30215.12,"maximum":34251.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34251.32},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30215.12}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures Without Mcc","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17661.47,"maximum":20020.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20020.72},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17661.47}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10844.29,"maximum":14977.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14977.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11061.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11061.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13212.94},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10844.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6813.53,"maximum":9042.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9042.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7976.48},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6813.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4773.97,"maximum":6143.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6143.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4869.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4869.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5419.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4773.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12078.65,"maximum":15573.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15573.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12320.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12320.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13737.95},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12078.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":984.87,"10th_percentile":984.87,"90th_percentile":984.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6955.22,"maximum":9082.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9082.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7094.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7094.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8011.86},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6955.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4955.17,"maximum":6329.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6329.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5054.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5054.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5583.78},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4955.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14569.18,"maximum":19231.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19231.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14860.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14860.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16965.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14569.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8240.0,"maximum":10789.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10789.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8404.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8404.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9517.75},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8240.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6296.49,"maximum":8134.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8134.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6422.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7175.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6296.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12452.64,"maximum":16522.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16522.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12701.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12701.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14575.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12452.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6680.69,"maximum":8870.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8870.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7825.33},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6680.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4294.39,"maximum":5813.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5813.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4380.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5128.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4294.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13366.84,"maximum":17538.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17538.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13634.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15471.37},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13366.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7380.98,"maximum":9877.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9877.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7528.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8713.75},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7380.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5453.82,"maximum":6637.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6637.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5562.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5562.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5855.53},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9405.56,"maximum":12331.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12331.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9593.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9593.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10878.12},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9405.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5823.04,"maximum":7717.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7717.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6808.27},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5823.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10778.89,"maximum":14163.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14163.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12494.16},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10778.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6650.72,"maximum":8789.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8789.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6783.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7753.78},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4641.13,"maximum":5889.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5889.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4733.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4733.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5195.45},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4641.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10060.21,"maximum":13403.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13403.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10261.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10261.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11823.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10060.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5380.25,"maximum":7190.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7190.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5487.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5487.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6342.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5380.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":6188.26,"10th_percentile":6188.26,"90th_percentile":6188.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3705.82,"maximum":4924.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4924.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4344.01},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3705.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":308.31,"10th_percentile":308.31,"90th_percentile":308.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8639.87,"maximum":11291.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11291.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8812.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8812.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9960.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8639.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5310.77,"maximum":6967.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6967.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5416.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5416.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6146.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5310.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3222.08,"10th_percentile":3222.08,"90th_percentile":3222.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":691.24,"10th_percentile":691.24,"90th_percentile":691.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":8646.0,"10th_percentile":8646.0,"90th_percentile":20474.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10894.7,"maximum":14470.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14470.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11112.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11112.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12765.11},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10894.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6374.15,"maximum":8410.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8410.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6501.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7419.31},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6374.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5914.99,"10th_percentile":5914.99,"90th_percentile":5914.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4421.1,"maximum":5813.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5813.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4509.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4509.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5128.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4421.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16314.46,"maximum":21719.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21719.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16640.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16640.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19160.12},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16314.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10310.9,"maximum":13870.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13870.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10517.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10517.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12236.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10310.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23424.32,"maximum":30791.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30791.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23892.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23892.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27163.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23424.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9522.73,"maximum":13565.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13565.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9713.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11966.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9522.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15841.7,"maximum":20820.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20820.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16158.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16158.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18367.38},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15841.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29924.49,"maximum":39536.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39536.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30522.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30522.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34877.52},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29924.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9162.37,"maximum":12669.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12669.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9345.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9345.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11176.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9162.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11460.79,"maximum":15665.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15665.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11690.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13819.15},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11460.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19768.91,"maximum":25091.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25091.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20164.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20164.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22134.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19768.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7955.25,"maximum":11135.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11135.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8114.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8114.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9823.27},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7955.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10385.15,"maximum":14251.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14251.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12572.15},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10385.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16975.24,"maximum":23485.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23485.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17314.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17314.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20718.28},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16975.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5930.67,"maximum":8321.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8321.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6049.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6049.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7340.52},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5930.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8915.76,"maximum":10868.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10868.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9094.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9094.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9587.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8915.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15638.01,"maximum":21493.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21493.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15950.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18960.73},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15638.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8080.59,"maximum":11545.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11545.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10185.07},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8080.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10250.27,"maximum":13619.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13619.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10455.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10455.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12014.17},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10250.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17594.47,"maximum":25706.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25706.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17946.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17946.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22676.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17594.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10456.68,"maximum":13894.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13894.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10665.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10665.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12256.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":15384.0,"10th_percentile":15384.0,"90th_percentile":15384.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14364.82,"maximum":19158.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19158.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14652.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14652.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16900.88},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14364.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24325.57,"maximum":31927.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31927.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24812.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28164.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24325.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11157.65,"maximum":15348.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15348.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11380.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11380.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13540.16},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11157.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15955.46,"maximum":19395.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19395.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16274.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16274.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17109.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24664.82,"maximum":34514.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34514.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25158.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25158.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30447.48},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24664.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11464.2,"maximum":15920.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15920.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11693.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14044.27},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11464.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":28042.0,"10th_percentile":28042.0,"90th_percentile":28042.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16330.13,"maximum":22110.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22110.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16656.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16656.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19505.04},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16330.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":14644.55,"10th_percentile":14644.55,"90th_percentile":14644.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1331.77,"10th_percentile":1331.77,"90th_percentile":1331.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31312.13,"maximum":41445.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41445.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31938.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31938.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36561.1},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31312.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1331.77,"10th_percentile":1331.77,"90th_percentile":1331.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10915.14,"maximum":15008.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15008.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11133.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11133.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13239.47},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10915.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16650.3,"maximum":22311.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22311.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16983.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16983.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19682.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16650.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33975.0,"maximum":45055.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45055.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34654.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34654.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39745.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33975.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21869.78,"maximum":30398.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30398.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22307.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22307.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26816.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21869.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21465.14,"maximum":29081.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29081.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21894.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21894.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25654.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21465.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29478.97,"maximum":40424.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40424.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30068.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30068.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35660.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29478.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12009.85,"maximum":16175.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16175.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12250.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12250.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14269.39},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12009.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18534.55,"maximum":24741.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24741.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18905.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18905.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21826.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18534.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16385.31,"maximum":19729.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19729.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16713.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16713.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17404.99},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16385.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30402.02,"maximum":38883.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38883.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31010.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31010.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34301.86},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30402.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16500.43,"maximum":23864.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23864.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16830.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16830.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21051.94},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16500.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45549.56,"maximum":64609.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64609.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46460.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46460.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56995.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45549.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4646.58,"maximum":6086.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6086.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4739.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4739.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5369.11},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4646.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6562.16,"maximum":8668.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8668.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6693.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7646.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6562.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14204.73,"maximum":19021.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19021.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14488.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16780.28},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14204.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":17062.01,"10th_percentile":17062.01,"90th_percentile":17062.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4904.76,"maximum":6482.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6482.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5002.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5002.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5718.85},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4904.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5937.49,"maximum":7891.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7891.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6056.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6961.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5937.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":26154.01,"10th_percentile":26154.01,"90th_percentile":26154.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4781.46,"maximum":6089.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6089.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4877.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5371.52},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4781.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3856.37,"maximum":5182.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5182.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3933.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3933.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4571.54},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3856.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5011.71,"maximum":6670.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6670.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5111.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5111.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5884.48},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5011.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":416.54,"10th_percentile":416.54,"90th_percentile":416.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8201.85,"maximum":10762.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8365.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8365.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9494.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6220.87,"maximum":8335.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8335.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6345.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7353.38},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6220.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10734.61,"maximum":14087.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14087.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10949.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12427.43},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10734.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5143.87,"maximum":6907.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6907.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5246.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5246.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6093.52},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8106.48,"maximum":10945.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10945.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8268.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8268.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9656.04},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8106.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":8971.68,"10th_percentile":8971.68,"90th_percentile":8971.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"1 through 10","median_amount":7524.81,"10th_percentile":7524.81,"90th_percentile":7524.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4585.95,"maximum":6024.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6024.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4677.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4677.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5314.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4585.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8151.44,"maximum":10930.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10930.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8314.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8314.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9642.37},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8151.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4902.72,"maximum":6500.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6500.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5734.13},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4902.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7271.99,"maximum":9536.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9536.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7417.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7417.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8413.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7271.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11122.23,"maximum":14436.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14436.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11344.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12735.36},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11122.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3100.22,"maximum":4505.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4505.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3162.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3162.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3974.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3100.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4318.91,"maximum":7083.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7083.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4405.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4405.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6248.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4318.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10639.92,"maximum":13665.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13665.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10852.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10852.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12055.18},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10639.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6349.99,"maximum":7198.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7198.24},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6349.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9872.32,"maximum":11191.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11191.08},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9872.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3855.69,"maximum":4976.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4976.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3932.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3932.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4389.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3855.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5783.53,"maximum":7849.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7849.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5899.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6924.85},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5783.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8745.46,"maximum":11561.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11561.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8920.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8920.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10198.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8745.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5171.86,"10th_percentile":5171.86,"90th_percentile":5171.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":12016.04,"10th_percentile":12016.04,"90th_percentile":12016.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":7958.77,"10th_percentile":7958.77,"90th_percentile":7958.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":2509.5,"10th_percentile":2509.5,"90th_percentile":2509.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":7997.67,"10th_percentile":7997.67,"90th_percentile":7997.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6333.27,"maximum":7625.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7625.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6459.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6459.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6727.07},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6333.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11627.69,"maximum":14000.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14000.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11860.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11860.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12351.05},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11627.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18435.09,"maximum":23973.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23973.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18803.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18803.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21148.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18435.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7289.7,"maximum":9830.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9830.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7435.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7435.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8671.94},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7289.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15073.96,"maximum":20212.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20212.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15375.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15375.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17830.31},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15073.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4079.81,"maximum":4912.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4912.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4161.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4161.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4333.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4079.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4715.38,"maximum":6866.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6866.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4809.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4809.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6057.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4715.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13493.54,"maximum":17877.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17877.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13763.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15770.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13493.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4925.88,"maximum":6724.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6724.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5024.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5024.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5931.91},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4925.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":388.97,"10th_percentile":388.97,"90th_percentile":388.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":388.97,"10th_percentile":388.97,"90th_percentile":388.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6261.06,"maximum":8369.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8369.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6386.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6386.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7383.13},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6261.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":10591.14,"10th_percentile":10591.14,"90th_percentile":10591.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":13071.44,"10th_percentile":13071.44,"90th_percentile":13071.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10927.4,"maximum":14684.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14684.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11145.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11145.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12954.05},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10927.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":776.0,"10th_percentile":776.0,"90th_percentile":776.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":12039.6,"10th_percentile":12039.6,"90th_percentile":12039.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":660.0,"10th_percentile":660.0,"90th_percentile":660.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24567.4,"maximum":37652.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37652.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25058.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25058.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33215.65},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24567.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37917.89,"maximum":57856.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57856.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38676.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38676.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51038.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37917.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31462.0,"maximum":42753.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42753.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32091.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32091.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37715.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31462.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40917.97,"maximum":56526.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56526.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41736.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41736.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49865.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40917.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48573.48,"maximum":65229.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65229.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49544.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49544.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57543.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48573.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22423.61,"maximum":30367.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30367.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22872.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22872.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26789.28},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28103.6,"maximum":39175.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39175.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28665.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28665.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34559.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28103.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17391.46,"maximum":22651.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22651.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17739.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17739.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19982.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17391.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24226.11,"maximum":32786.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32786.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24710.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24710.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28923.1},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24226.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35943.04,"maximum":47998.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47998.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36661.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36661.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42342.66},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35943.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28769.15,"maximum":38813.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38813.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29344.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29344.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34239.95},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28769.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46853.41,"maximum":65308.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65308.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47790.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47790.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57612.23},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46853.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32431.37,"maximum":43028.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43028.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33080.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33080.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37957.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32431.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41747.69,"maximum":54113.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54113.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42582.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42582.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47736.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41747.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24647.78,"maximum":29678.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29678.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25140.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25140.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26181.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24647.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22756.73,"maximum":30446.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30446.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23211.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23211.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26858.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22756.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20827.52,"maximum":29547.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29547.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21244.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21244.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26065.68},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20827.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11103.15,"maximum":14854.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14854.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11325.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11325.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13104.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11103.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12878.4,"maximum":17230.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17230.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13135.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13135.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15199.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22158.62,"maximum":29646.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29646.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22601.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22601.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26152.51},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22158.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13774.88,"maximum":18429.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18429.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14050.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14050.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16257.68},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13774.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21404.51,"maximum":28637.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28637.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21832.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21832.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25262.48},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21404.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7440.25,"maximum":9526.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9526.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7589.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7589.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8404.21},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7440.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11566.38,"maximum":15229.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15229.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11797.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11797.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13434.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11566.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18375.14,"maximum":25786.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25786.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18742.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18742.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22747.57},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18375.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12137.24,"maximum":16369.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16369.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12379.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12379.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14440.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12137.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17681.66,"maximum":23937.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23937.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18035.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18035.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21117.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17681.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23762.88,"maximum":31736.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31736.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24238.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24238.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27996.89},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23762.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10180.78,"maximum":15165.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15165.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10384.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10384.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13378.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10180.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14867.56,"maximum":21319.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21319.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15164.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18807.17},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14867.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31079.83,"maximum":42345.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42345.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31701.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31701.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37355.45},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31079.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12312.99,"maximum":16077.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16077.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12559.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14182.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12312.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14516.05,"maximum":19210.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19210.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14806.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14806.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16946.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21749.89,"maximum":28467.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28467.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22184.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22184.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25112.94},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21749.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9430.76,"maximum":13509.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13509.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9619.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11917.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9430.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19418.08,"maximum":26861.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26861.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19806.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19806.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23696.29},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19418.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33527.45,"maximum":45580.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45580.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34198.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34198.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40208.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33527.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28534.81,"maximum":39533.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39533.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29105.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29105.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34875.11},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28534.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39977.89,"maximum":53339.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53339.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40777.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40777.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47054.1},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39977.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37212.83,"maximum":50164.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50164.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37957.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37957.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44252.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37212.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52080.38,"maximum":73054.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73054.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53121.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53121.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":64445.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52080.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41299.45,"maximum":56756.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56756.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42125.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42125.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50068.3},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41299.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":57425.89,"maximum":79974.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79974.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58574.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58574.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70550.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57425.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21454.92,"maximum":31355.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31355.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21884.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21884.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27660.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21454.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33702.52,"maximum":45260.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45260.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34376.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34376.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39926.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33702.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34334.69,"maximum":42957.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42957.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35021.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35021.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37895.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34334.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36327.93,"maximum":50183.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50183.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37054.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37054.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44269.85},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36327.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52305.87,"maximum":69634.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69634.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53351.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53351.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61428.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52305.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44792.05,"maximum":62022.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62022.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54713.81},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44792.05,"maximum":62022.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62022.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45687.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54713.81},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44792.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66642.07,"maximum":90067.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90067.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67974.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67974.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79453.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":66642.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":67828.75,"maximum":92430.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92430.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69185.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":69185.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81538.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":67828.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38876.36,"maximum":53294.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53294.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39653.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39653.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47013.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38876.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74076.19,"maximum":104278.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104278.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75557.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75557.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91990.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":74076.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Or Device Replacement Without Mcc","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14549.18,"maximum":16492.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16492.69},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14549.18}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Or Device Replacement With Mcc","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26256.23,"maximum":29763.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29763.59},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26256.23}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":77105.56,"maximum":104958.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":104958.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78647.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78647.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":92590.25},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77105.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18724.61,"maximum":25072.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25072.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19099.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19099.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22118.04},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18724.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43834.25,"maximum":58305.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58305.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44710.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44710.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51435.1},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":43834.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6410.93,"maximum":8435.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8435.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6539.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6539.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7441.02},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6410.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12473.08,"maximum":16627.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16627.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12722.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12722.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14668.18},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12473.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5500.14,"maximum":7480.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7480.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5610.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5610.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6599.23},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5500.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4564.15,"maximum":5932.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5932.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4655.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4655.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5233.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4564.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6615.98,"maximum":8632.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8632.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6748.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7615.49},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6615.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":7774.1,"10th_percentile":7774.1,"90th_percentile":7774.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4871.38,"maximum":6181.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6181.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4968.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4968.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5452.73},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4871.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7488.62,"maximum":9816.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9816.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7638.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8659.88},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12017.34,"maximum":15779.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15779.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12257.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12257.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13920.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12017.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4878.87,"maximum":6613.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6613.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4976.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5833.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4878.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6465.43,"maximum":8650.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8650.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6594.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6594.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7630.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6465.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12855.92,"maximum":16710.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16710.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13113.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13113.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14741.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12855.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4281.45,"maximum":5524.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5524.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4367.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4873.85},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4281.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":4833.17,"10th_percentile":4833.17,"90th_percentile":4833.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5489.93,"maximum":7187.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7187.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5599.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6340.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5489.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":433.5,"10th_percentile":433.5,"90th_percentile":433.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8953.91,"maximum":11687.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11687.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9132.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9132.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10310.5},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8953.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":7628.22,"10th_percentile":7628.22,"90th_percentile":7628.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":3788.0,"10th_percentile":3788.0,"90th_percentile":3788.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":707.04,"10th_percentile":707.04,"90th_percentile":742.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1750.0,"10th_percentile":1750.0,"90th_percentile":1750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4373.41,"maximum":5728.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5728.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4460.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4460.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5053.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4373.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":345.34,"10th_percentile":345.34,"90th_percentile":345.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5742.66,"maximum":7527.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7527.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6640.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5742.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7545.84,"maximum":9796.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9796.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7696.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7696.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8642.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7545.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":609.8,"10th_percentile":609.8,"90th_percentile":609.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":595.85,"10th_percentile":595.85,"90th_percentile":595.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":6659.25,"10th_percentile":6659.25,"90th_percentile":6659.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8415.75,"maximum":11034.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11034.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8584.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9734.03},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8415.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":664.54,"10th_percentile":664.54,"90th_percentile":664.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":3530.38,"10th_percentile":3530.38,"90th_percentile":3530.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":664.54,"10th_percentile":664.54,"90th_percentile":664.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":5459.27,"10th_percentile":5459.27,"90th_percentile":5459.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4885.69,"maximum":6061.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6061.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4983.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4983.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5347.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4885.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6737.91,"maximum":9116.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9116.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6872.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8042.41},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6737.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10616.76,"maximum":14437.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14437.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10829.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10829.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12736.16},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10616.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5357.77,"maximum":7028.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7028.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5464.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6200.45},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5357.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7248.83,"maximum":9701.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9701.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7393.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7393.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8558.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7248.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":572.4,"10th_percentile":572.4,"90th_percentile":572.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10421.94,"maximum":13583.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13583.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10630.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10630.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11982.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10421.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5135.01,"maximum":6777.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6777.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5237.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5237.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5978.54},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5135.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7295.83,"maximum":9966.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9966.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7441.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7441.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8791.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12030.29,"maximum":16222.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16222.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12270.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12270.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14311.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12030.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5143.19,"maximum":6693.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6693.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5246.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5246.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5904.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5143.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6648.68,"maximum":8878.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8878.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6781.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6781.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7832.57},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6648.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10645.37,"maximum":14665.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14665.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10858.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10858.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12937.16},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10645.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":840.6,"10th_percentile":840.6,"90th_percentile":840.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5483.79,"maximum":7346.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7346.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5593.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6481.04},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5483.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5929.56,"10th_percentile":5929.56,"90th_percentile":5929.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9357.19,"maximum":12441.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12441.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9544.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10975.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9357.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":738.88,"10th_percentile":738.88,"90th_percentile":738.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20275.74,"maximum":26928.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26928.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20681.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20681.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23754.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20275.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9308.15,"maximum":12659.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12659.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9494.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11167.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9308.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12285.06,"maximum":16626.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16626.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12530.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14667.37},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12285.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25461.84,"maximum":35302.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35302.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25971.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25971.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31142.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25461.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13039.85,"maximum":17576.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17576.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13300.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13300.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15505.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13039.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17193.91,"maximum":22922.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22922.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17537.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17537.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20221.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17193.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30530.77,"maximum":40907.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40907.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31141.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31141.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36086.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30530.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4826.42,"maximum":6279.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6279.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4922.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4922.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5539.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4826.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6197.71,"maximum":8535.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8535.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6321.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6321.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7529.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6197.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11695.13,"maximum":16479.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16479.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14537.93},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11695.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4707.89,"maximum":6066.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6066.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4802.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4802.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5351.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4707.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6243.35,"maximum":8492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8492.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6368.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7491.67},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6243.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10650.82,"maximum":14505.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14505.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10863.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12796.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10650.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5028.74,"maximum":6762.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6762.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5129.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5965.68},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5028.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8053.34,"maximum":10159.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10159.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8214.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8962.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8053.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5000.13,"maximum":6937.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6937.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5100.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6120.05},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9070.4,"maximum":13211.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13211.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9251.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9251.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11654.78},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9070.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5120.03,"maximum":6859.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6859.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6050.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5120.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5429.98,"maximum":7295.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7295.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5538.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5538.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6436.02},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5429.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8661.67,"maximum":11892.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11892.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8834.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8834.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10491.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8661.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14424.08,"maximum":19437.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19437.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14712.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14712.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17146.91},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14424.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8190.27,"maximum":11242.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11242.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8354.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9917.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8190.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11804.81,"maximum":16247.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16247.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12040.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12040.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14332.91},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11804.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25522.47,"maximum":35088.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35088.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26032.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26032.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30954.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10874.94,"maximum":15527.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15527.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11092.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13697.75},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10874.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14858.02,"maximum":20368.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20368.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15155.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17968.6},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14858.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29055.94,"maximum":39280.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39280.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29637.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29637.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34651.6},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29055.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8417.8,"maximum":10519.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10519.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8586.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8586.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9279.77},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8417.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6036.94,"maximum":8370.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8370.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6157.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6157.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7383.94},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6036.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10171.93,"maximum":12248.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12248.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10375.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10375.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10804.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10171.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6916.39,"maximum":9674.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9674.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8534.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6916.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14782.4,"maximum":19862.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19862.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15078.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15078.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17521.57},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14782.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5230.38,"maximum":7016.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7016.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5334.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5334.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6190.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5230.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9013.18,"maximum":11365.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11365.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9193.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10025.88},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9013.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":3048.0,"10th_percentile":3048.0,"90th_percentile":3048.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5440.2,"maximum":7489.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7489.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5549.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5549.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6607.27},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5440.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5353.0,"maximum":6747.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6747.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5952.01},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5353.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7924.59,"maximum":11163.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11163.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8083.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9848.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7924.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7390.52,"maximum":9674.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9674.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7538.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8534.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7390.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12317.08,"maximum":14831.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14831.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12563.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13083.49},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12317.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10456.0,"maximum":13479.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13479.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10665.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10665.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11891.16},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10456.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9216.86,"maximum":11531.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11531.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9401.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9401.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10172.21},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9216.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16016.09,"maximum":19391.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19391.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16336.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16336.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17106.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16016.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5697.02,"maximum":7490.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7490.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6608.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5697.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7635.76,"maximum":10207.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10207.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7788.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7788.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9004.8},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7635.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6148.66,"maximum":8158.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8158.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6271.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6271.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7197.41},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6148.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13193.81,"maximum":17531.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17531.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13457.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13457.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15465.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13193.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9280.9,"maximum":13897.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13897.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9466.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9466.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12260.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15633.24,"maximum":20698.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20698.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15945.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18259.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15633.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24604.19,"maximum":34822.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34822.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25096.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25096.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30719.23},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24604.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17569.94,"maximum":21156.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21156.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18663.25},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17569.94,"maximum":21415.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21415.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17921.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18891.59},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17569.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23974.74,"maximum":31087.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31087.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24454.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24454.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27424.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23974.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5424.53,"maximum":7093.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7093.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5533.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5533.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6257.53},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5424.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":428.34,"10th_percentile":428.34,"90th_percentile":428.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6968.85,"maximum":9330.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9330.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7108.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7108.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8231.35},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6968.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":550.29,"10th_percentile":550.29,"90th_percentile":550.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11963.53,"maximum":15539.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15539.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12202.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12202.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13708.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11963.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5607.78,"maximum":7546.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7546.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5719.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6657.12},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5607.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7483.85,"maximum":10317.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10317.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7633.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7633.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9102.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7483.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9208.69,"maximum":13002.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13002.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9392.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11470.67},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9208.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6231.09,"maximum":8402.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8402.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6355.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6355.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7412.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6231.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8874.21,"maximum":11904.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11904.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9051.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9051.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10501.85},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8874.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15476.56,"maximum":20455.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20455.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15786.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18044.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15476.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6511.07,"maximum":8750.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8750.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6641.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6641.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7719.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6511.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9508.42,"maximum":12603.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12603.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9698.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9698.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11118.52},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9508.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15569.89,"maximum":20900.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20900.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15881.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15881.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18437.33},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15569.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6100.98,"maximum":7345.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7345.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6223.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6480.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12330.02,"maximum":15927.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15927.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12576.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12576.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14050.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12330.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5360.27,"maximum":6076.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6076.3},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5360.27}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8022.31,"maximum":9093.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9093.95},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8022.31}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12431.45,"maximum":14092.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14092.07},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12431.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5621.4,"maximum":7903.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7903.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5733.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6972.29},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5621.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13062.33,"maximum":16130.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16130.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13323.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13323.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14230.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13062.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7021.98,"maximum":9270.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9270.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7162.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8178.29},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7021.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10928.76,"maximum":14375.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14375.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11147.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11147.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12681.49},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10928.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5151.36,"maximum":6693.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6693.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5254.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5254.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5904.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5151.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6989.28,"maximum":9271.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9271.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8179.09},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6989.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":551.91,"10th_percentile":551.91,"90th_percentile":551.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11340.9,"maximum":14663.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14663.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11567.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11567.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12935.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11340.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":10364.94,"10th_percentile":10364.94,"90th_percentile":10364.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5441.56,"maximum":7256.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7256.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5550.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5550.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6401.45},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5441.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5888.44,"maximum":8212.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8212.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6006.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6006.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7244.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5888.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10005.03,"maximum":13018.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13018.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10205.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11484.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10005.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4662.25,"maximum":6170.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6170.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4755.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5443.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4662.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":4071.6,"10th_percentile":4071.6,"90th_percentile":4071.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6882.33,"maximum":9030.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9030.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7019.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7019.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7966.03},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6882.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13699.27,"maximum":17968.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17968.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13973.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15850.86},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13699.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9562.92,"maximum":13264.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13264.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11701.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9562.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11970.34,"maximum":16206.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16206.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12209.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14296.73},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11970.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18781.83,"maximum":24800.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24800.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19157.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21877.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18781.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6265.83,"maximum":8428.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8428.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6391.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7435.39},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6265.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8453.22,"maximum":10934.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10934.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8622.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8622.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9645.59},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8453.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11645.4,"maximum":16797.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16797.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11878.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11878.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14817.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11645.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8825.84,"maximum":11697.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11697.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9002.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9002.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10319.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8825.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15825.35,"maximum":20642.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20642.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16141.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18209.8},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15825.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6945.69,"maximum":9379.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9379.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7084.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7084.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8273.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6945.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10401.5,"maximum":13850.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13850.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10609.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10609.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12218.39},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10401.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6670.47,"maximum":8861.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8861.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6803.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6803.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7817.29},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6670.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12338.88,"maximum":16262.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16262.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12585.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12585.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14345.77},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12338.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11769.38,"maximum":15272.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15272.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12004.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12004.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13472.63},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11769.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":12463.78,"10th_percentile":12463.78,"90th_percentile":12463.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14977.91,"maximum":19863.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19863.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15277.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15277.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17523.18},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14977.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26303.14,"maximum":33874.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33874.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26829.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26829.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29883.07},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26303.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8007.7,"maximum":10807.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10807.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8167.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8167.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9533.83},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8007.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11053.42,"maximum":14860.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14860.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11274.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13109.22},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11053.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22426.34,"maximum":31198.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31198.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22874.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22874.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27521.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22426.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13234.68,"maximum":17495.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17495.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13499.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13499.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15433.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13234.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16284.49,"maximum":21921.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21921.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16610.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16610.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19338.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16284.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26367.86,"maximum":35468.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35468.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26895.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26895.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31288.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26367.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11327.95,"maximum":15761.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15761.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11554.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11554.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13904.38},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14516.73,"maximum":18614.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18614.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14807.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14807.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16420.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14516.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30521.92,"maximum":38822.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38822.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31132.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31132.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34247.99},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30521.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14954.07,"maximum":20563.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20563.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15253.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15253.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18139.85},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14954.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":9389.25,"10th_percentile":9389.25,"90th_percentile":9389.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":15195.05,"10th_percentile":15195.05,"90th_percentile":15195.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23240.39,"maximum":32053.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32053.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23705.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23705.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28275.88},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23240.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40929.55,"maximum":56050.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56050.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41748.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41748.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49445.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40929.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17186.42,"maximum":23999.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23999.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17530.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17530.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21171.73},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17186.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21180.39,"maximum":29080.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29080.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21604.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21604.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25654.03},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21180.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30972.88,"maximum":42027.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42027.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31592.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31592.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37074.85},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30972.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26648.52,"maximum":36173.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36173.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31910.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26648.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39035.76,"maximum":52334.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52334.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39816.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39816.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46167.29},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39035.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21644.98,"maximum":30549.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30549.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22077.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22077.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26949.28},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21644.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36062.25,"maximum":49856.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49856.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36783.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36783.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43981.21},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36062.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53603.58,"maximum":72541.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72541.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54675.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":54675.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63993.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":53603.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48602.09,"maximum":68775.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68775.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49574.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49574.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60670.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48602.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":294168.47,"maximum":411289.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":411289.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300051.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":300051.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":362822.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":294168.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37005.74,"maximum":44559.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44559.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37745.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37745.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39308.36},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37005.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40394.11,"maximum":54807.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54807.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41201.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41201.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48349.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40394.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":81867.95,"maximum":107445.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":107445.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83505.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":83505.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":94784.36},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":81867.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19631.3,"maximum":24877.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24877.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20023.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20023.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21945.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19631.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28720.1,"maximum":39911.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39911.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29294.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29294.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35207.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28720.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37154.24,"maximum":51155.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51155.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37897.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37897.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45127.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37154.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Or Islet Cell Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48882.07,"maximum":68561.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68561.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49859.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49859.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60482.51},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48882.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas, Islet Cell And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38179.47,"maximum":50238.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50238.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38943.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38943.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44318.09},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38179.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":88218.93,"maximum":135528.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":135528.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89983.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":89983.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":119558.02},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88218.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31588.02,"maximum":41701.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41701.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32219.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32219.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36787.02},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31588.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":70236.85,"maximum":95460.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":95460.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71641.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":71641.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":84211.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":70236.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":94358.06,"maximum":123836.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":123836.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96245.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":96245.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":109243.5},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":94358.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":144589.62,"maximum":193890.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":193890.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147481.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":147481.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":171042.16},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":144589.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":77194.12,"maximum":100289.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":100289.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78738.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":78738.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":88471.36},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":77194.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":190903.5,"maximum":255946.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":255946.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194721.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194721.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":225785.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190903.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7797.89,"maximum":10965.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10965.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7953.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9672.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7797.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":10182.0,"10th_percentile":10182.0,"90th_percentile":10182.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16280.2,"maximum":18454.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18454.94},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16280.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17388.5,"maximum":37322.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37322.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":17388.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27936.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27936.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32924.6},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27388.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36642.83,"10th_percentile":36642.83,"90th_percentile":36642.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2162.69,"10th_percentile":2162.69,"90th_percentile":24947.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":28430.78,"10th_percentile":21057.01,"90th_percentile":32904.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"20","median_amount":26154.01,"10th_percentile":19453.05,"90th_percentile":36861.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"15","median_amount":2162.69,"10th_percentile":2162.69,"90th_percentile":24975.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2162.69,"10th_percentile":2162.69,"90th_percentile":2162.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"47","median_amount":14059.82,"10th_percentile":9100.86,"90th_percentile":22852.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"1 through 10","median_amount":30917.65,"10th_percentile":30917.65,"90th_percentile":33394.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"20","median_amount":2162.69,"10th_percentile":2162.69,"90th_percentile":2487.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"19","median_amount":28430.78,"10th_percentile":27658.1,"90th_percentile":28870.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2162.69,"10th_percentile":2162.69,"90th_percentile":24936.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":30917.65,"10th_percentile":30084.82,"90th_percentile":30917.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"30","median_amount":2204.24,"10th_percentile":2162.69,"90th_percentile":24966.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":24939.58,"10th_percentile":24939.58,"90th_percentile":24939.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Or Knee Procedures With Principal Diagnosis Of Periprosthetic Joint Infection With Mcc Or Insert","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40240.2,"maximum":45615.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45615.57},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40240.2}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Or Knee Procedures With Principal Diagnosis Of Periprosthetic Joint Infection Without Mcc","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26146.88,"maximum":29639.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29639.64},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26146.88}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37265.96,"maximum":49047.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49047.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38011.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38011.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43268.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37265.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19756.65,"maximum":26868.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26868.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20151.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20151.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23701.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19756.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15120.29,"maximum":19777.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19777.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15422.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15422.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17446.8},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15120.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24289.46,"maximum":30276.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30276.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24775.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24775.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26708.88},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24289.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14832.13,"maximum":20343.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20343.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15128.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17946.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14832.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10815.68,"maximum":16090.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16090.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11031.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14194.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10815.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22502.63,"maximum":27095.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27095.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22952.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22952.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23902.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14322.58,"maximum":19616.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19616.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14609.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17305.3},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14322.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11311.6,"maximum":16672.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16672.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11537.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11537.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14707.57},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11311.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24269.03,"maximum":33198.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33198.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24754.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24754.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29286.5},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24269.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14078.71,"maximum":18298.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18298.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14360.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14360.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16141.91},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14078.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9287.03,"maximum":12860.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12860.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9472.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9472.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11345.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9287.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16256.56,"maximum":21881.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21881.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16581.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16581.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19303.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16256.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1338.98,"10th_percentile":1338.98,"90th_percentile":1338.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":17196.68,"10th_percentile":17196.68,"90th_percentile":17196.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11523.46,"maximum":15825.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15825.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11753.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11753.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13960.66},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11523.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9304.06,"maximum":12855.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12855.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9490.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11340.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9304.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23209.74,"maximum":27947.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27947.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23673.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23673.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24653.86},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23209.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11836.14,"maximum":15616.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15616.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12072.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12072.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13776.54},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11836.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9533.63,"maximum":12986.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12986.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9724.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9724.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11456.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9533.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28290.93,"maximum":37973.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37973.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28856.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28856.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33498.66},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28290.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14904.34,"maximum":19673.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19673.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17355.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14904.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10220.3,"maximum":17151.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17151.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10424.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15130.48},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10220.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17388.5,"maximum":90402.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":90402.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75078.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":75078.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75078.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75078.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":17388.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75078.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75078.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":76579.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Plan","methodology":"fee schedule","standard_charge_dollar":75078.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":75078.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5928.49,"10th_percentile":5928.49,"90th_percentile":5928.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5928.49,"10th_percentile":5928.49,"90th_percentile":5928.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":32643.0,"10th_percentile":32643.0,"90th_percentile":32643.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5928.49,"10th_percentile":5928.49,"90th_percentile":5928.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5928.49,"10th_percentile":5928.49,"90th_percentile":7628.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17388.5,"maximum":61084.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61084.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":17388.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50157.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":50157.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53886.49},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49174.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":64734.01,"10th_percentile":64734.01,"90th_percentile":64734.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3883.0,"10th_percentile":3883.0,"90th_percentile":3883.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":48667.38,"10th_percentile":48667.38,"90th_percentile":48667.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":44794.53,"10th_percentile":44794.53,"90th_percentile":44794.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3883.0,"10th_percentile":3883.0,"90th_percentile":3883.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":22362.0,"10th_percentile":22362.0,"90th_percentile":56980.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3883.0,"10th_percentile":3856.87,"90th_percentile":4001.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":22351.31,"10th_percentile":22351.31,"90th_percentile":22351.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":55511.03,"10th_percentile":55511.03,"90th_percentile":55511.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":4001.85,"10th_percentile":3883.0,"90th_percentile":44793.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17388.5,"maximum":53954.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53954.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":17388.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39063.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47596.8},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38298.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3024.16,"10th_percentile":3024.16,"90th_percentile":3024.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":32904.8,"10th_percentile":32904.8,"90th_percentile":32904.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":44950.52,"10th_percentile":31364.01,"90th_percentile":58336.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":34897.71,"10th_percentile":34897.71,"90th_percentile":34897.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"1 through 10","median_amount":46346.8,"10th_percentile":46346.8,"90th_percentile":46346.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3024.16,"10th_percentile":3024.16,"90th_percentile":3024.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"15","median_amount":20691.03,"10th_percentile":11181.0,"90th_percentile":36995.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"1 through 10","median_amount":41680.91,"10th_percentile":41680.91,"90th_percentile":41680.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2988.8,"10th_percentile":2988.8,"90th_percentile":2988.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"1 through 10","median_amount":3024.16,"10th_percentile":3024.16,"90th_percentile":3024.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3024.16,"10th_percentile":2988.8,"90th_percentile":3024.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":39470.04,"10th_percentile":39045.42,"90th_percentile":39836.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":21218.79,"10th_percentile":21218.79,"90th_percentile":21218.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3101.16,"10th_percentile":3101.16,"90th_percentile":34868.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":43233.18,"10th_percentile":42326.53,"90th_percentile":43233.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3101.16,"10th_percentile":3024.16,"90th_percentile":34895.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3024.16,"10th_percentile":3024.16,"90th_percentile":3024.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17388.5,"maximum":80579.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80579.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":17388.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62602.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":62602.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71084.05},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":61374.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17388.5,"maximum":53718.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53718.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":17388.5},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40072.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40072.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47388.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39286.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":32011.77,"10th_percentile":32011.77,"90th_percentile":32011.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3082.23,"10th_percentile":3082.23,"90th_percentile":3082.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13407.71,"maximum":18071.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18071.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13675.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15941.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13407.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7195.01,"maximum":9478.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9478.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7338.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8361.6},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7195.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4853.67,"maximum":5844.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5844.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4950.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4950.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5156.05},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4853.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12511.91,"maximum":16795.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16795.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12762.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12762.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14816.11},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12511.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7705.24,"maximum":10227.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10227.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7859.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7859.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9022.49},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7705.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5812.82,"maximum":7362.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7362.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5929.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5929.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6494.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5812.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11105.2,"maximum":14366.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14366.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12673.45},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11105.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5730.4,"maximum":7656.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7656.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5845.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5845.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6754.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5730.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7666.7,"10th_percentile":7666.7,"90th_percentile":7666.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":14551.09,"10th_percentile":14551.09,"90th_percentile":14551.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":6008.02,"10th_percentile":6008.02,"90th_percentile":6008.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":5404.49,"10th_percentile":5404.49,"90th_percentile":5404.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"1 through 10","median_amount":2239.49,"10th_percentile":2239.49,"90th_percentile":2239.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4233.08,"maximum":5437.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5437.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4317.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4317.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4796.66},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4233.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5458.01,"10th_percentile":5458.01,"90th_percentile":5458.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3876.0,"10th_percentile":3876.0,"90th_percentile":3876.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12225.8,"maximum":16611.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16611.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12470.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14653.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12225.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6575.79,"maximum":8751.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8751.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6707.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7720.01},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":8812.59,"10th_percentile":8812.59,"90th_percentile":8812.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4766.47,"maximum":6279.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6279.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4861.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4861.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5539.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4766.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11382.45,"maximum":15185.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15185.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11610.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11610.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13396.25},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11382.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7455.24,"maximum":9906.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9906.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7604.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7604.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8739.48},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7455.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5635.71,"maximum":7401.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7401.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5748.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5748.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6529.28},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5635.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":6188.26,"10th_percentile":6188.26,"90th_percentile":6188.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":2982.0,"10th_percentile":2982.0,"90th_percentile":2982.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45516.18,"maximum":63484.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63484.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46426.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46426.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56003.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45516.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28889.04,"maximum":39643.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39643.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29466.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29466.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34971.59},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28889.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2300.76,"10th_percentile":2300.76,"90th_percentile":2300.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":52427.09,"10th_percentile":52427.09,"90th_percentile":52427.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2217.4,"10th_percentile":2217.4,"90th_percentile":2217.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2281.19,"10th_percentile":2281.19,"90th_percentile":2281.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2281.19,"10th_percentile":2281.19,"90th_percentile":26309.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Prosthesis","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26535.22,"maximum":30079.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30079.85},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26535.22}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36306.13,"maximum":47701.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47701.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37032.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37032.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42080.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36306.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":33063.33,"10th_percentile":33063.33,"90th_percentile":33063.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":39407.29,"10th_percentile":39407.29,"90th_percentile":39407.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":33044.23,"10th_percentile":33044.23,"90th_percentile":33059.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22006.03,"maximum":29707.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29707.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22446.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22446.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26207.18},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22006.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29441.87,"10th_percentile":29441.87,"90th_percentile":29441.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1737.69,"10th_percentile":1737.69,"90th_percentile":1737.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":21057.01,"10th_percentile":21057.01,"90th_percentile":21057.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":33154.59,"10th_percentile":33154.59,"90th_percentile":49809.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1738.74,"10th_percentile":1738.74,"90th_percentile":1738.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1738.74,"10th_percentile":1738.74,"90th_percentile":1738.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"15","median_amount":22112.0,"10th_percentile":10831.0,"90th_percentile":34028.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"12","median_amount":1737.69,"10th_percentile":1737.69,"90th_percentile":1737.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":22999.01,"10th_percentile":22350.58,"90th_percentile":24668.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":20044.68,"10th_percentile":20044.68,"90th_percentile":20044.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":24841.78,"10th_percentile":24841.78,"90th_percentile":24841.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"11","median_amount":2425.0,"10th_percentile":1675.74,"90th_percentile":20068.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":18850.48,"10th_percentile":18850.48,"90th_percentile":18850.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection With Mcc","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19782.05,"maximum":69458.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69458.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":26150.48},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":19782.05},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47261.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58390.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58390.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61273.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":57245.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection With Cc","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16422.04,"maximum":48913.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48913.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":21727.43},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":16422.04},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31425.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41434.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41434.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43149.07},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40621.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Or Infection Without Cc/Mcc","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26027.0,"maximum":36794.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36794.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26027.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28992.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28992.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32458.28},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28424.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":22362.0,"10th_percentile":22362.0,"90th_percentile":22362.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":29505.72,"10th_percentile":29505.72,"90th_percentile":29505.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2244.51,"10th_percentile":2244.51,"90th_percentile":2244.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25280.0,"maximum":45302.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45302.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25280.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38376.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38376.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39964.43},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37623.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17498.0,"maximum":25999.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25999.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17498.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18482.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18482.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22935.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18120.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":20229.01,"10th_percentile":20229.01,"90th_percentile":20229.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1430.86,"10th_percentile":1430.86,"90th_percentile":1430.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28492.0,"maximum":46751.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46751.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28492.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39602.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39602.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41241.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38825.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":17403.0,"10th_percentile":17403.0,"90th_percentile":17403.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3065.85,"10th_percentile":3065.85,"90th_percentile":3065.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":40628.0,"10th_percentile":40628.0,"90th_percentile":40628.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15881.0,"maximum":28946.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28946.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15881.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21642.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21642.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25535.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21217.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1661.33,"10th_percentile":1661.33,"90th_percentile":1661.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":26928.0,"10th_percentile":26928.0,"90th_percentile":47985.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1675.45,"10th_percentile":1675.45,"90th_percentile":1675.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement Or Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders With","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9083.0,"maximum":22622.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22622.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9083.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19956.89},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":981.0,"10th_percentile":981.0,"90th_percentile":981.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25287.0,"maximum":47442.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47442.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25287.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36169.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36169.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41851.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35460.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2870.44,"10th_percentile":2870.44,"90th_percentile":2870.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":18375.79,"10th_percentile":18375.79,"90th_percentile":18375.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":53073.18,"10th_percentile":53073.18,"90th_percentile":53073.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":33978.0,"10th_percentile":33978.0,"90th_percentile":33978.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2800.08,"10th_percentile":2800.08,"90th_percentile":2800.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":23173.34,"10th_percentile":23173.34,"90th_percentile":23173.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":32315.27,"10th_percentile":32315.27,"90th_percentile":32315.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17048.0,"maximum":32141.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32141.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17048.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24504.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24504.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28353.86},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24023.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1897.02,"10th_percentile":1897.02,"90th_percentile":1897.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":25826.0,"10th_percentile":25826.0,"90th_percentile":25826.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":45908.85,"10th_percentile":45908.85,"90th_percentile":45908.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1929.86,"10th_percentile":1929.86,"90th_percentile":1929.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":34028.0,"10th_percentile":32643.0,"90th_percentile":45104.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"1 through 10","median_amount":1929.86,"10th_percentile":1929.86,"90th_percentile":1929.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1897.02,"10th_percentile":1897.02,"90th_percentile":1929.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":25430.66,"10th_percentile":25430.66,"90th_percentile":25430.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":21912.24,"10th_percentile":21912.24,"90th_percentile":21912.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":27119.55,"10th_percentile":27119.55,"90th_percentile":27119.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1929.86,"10th_percentile":1897.02,"90th_percentile":21915.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13636.0,"maximum":25045.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25045.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13636.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19094.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19094.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22093.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18719.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1478.19,"10th_percentile":1478.19,"90th_percentile":1478.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":13309.8,"10th_percentile":13309.8,"90th_percentile":13309.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":44176.35,"10th_percentile":44176.35,"90th_percentile":59209.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1478.04,"10th_percentile":1478.04,"90th_percentile":1478.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":16862.06,"10th_percentile":1478.19,"90th_percentile":16862.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":11181.0,"10th_percentile":10981.0,"90th_percentile":33537.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1478.19,"10th_percentile":1478.19,"90th_percentile":1478.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1478.19,"10th_percentile":1478.04,"90th_percentile":1478.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":19287.27,"10th_percentile":19287.27,"90th_percentile":19682.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1478.04,"10th_percentile":1478.04,"90th_percentile":1478.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":21132.12,"10th_percentile":21132.12,"90th_percentile":21132.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":17039.9,"10th_percentile":1478.04,"90th_percentile":17076.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1478.19,"10th_percentile":1478.19,"90th_percentile":1478.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18313.0,"maximum":28328.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28328.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18313.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21075.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21075.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24989.93},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20662.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11989.04,"10th_percentile":11989.04,"90th_percentile":11989.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1841.67,"10th_percentile":1841.67,"90th_percentile":1841.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1037.58,"10th_percentile":1037.58,"90th_percentile":1037.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":18446.11,"10th_percentile":18275.0,"90th_percentile":18675.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1631.61,"10th_percentile":1631.61,"90th_percentile":1631.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":24410.51,"10th_percentile":24410.51,"90th_percentile":24410.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":585.0,"10th_percentile":585.0,"90th_percentile":585.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":25136.3,"10th_percentile":25136.3,"90th_percentile":25136.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2970.0,"10th_percentile":2970.0,"90th_percentile":2970.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11175.0,"maximum":17826.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17826.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":17369.77},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11175.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13402.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13402.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15726.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13139.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1037.58,"10th_percentile":1037.58,"90th_percentile":1062.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11127.61,"10th_percentile":11127.61,"90th_percentile":13425.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":27657.27,"10th_percentile":24885.75,"90th_percentile":29338.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11997.76,"10th_percentile":1062.34,"90th_percentile":12006.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"20","median_amount":1037.58,"10th_percentile":1023.85,"90th_percentile":11030.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"155","median_amount":18775.0,"10th_percentile":16282.16,"90th_percentile":18975.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"1 through 10","median_amount":16523.5,"10th_percentile":16523.5,"90th_percentile":16523.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11964.2,"10th_percentile":11964.2,"90th_percentile":11964.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"1 through 10","median_amount":12050.16,"10th_percentile":12050.16,"90th_percentile":12050.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"21","median_amount":1037.58,"10th_percentile":1037.58,"90th_percentile":1062.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"37","median_amount":13670.78,"10th_percentile":13656.14,"90th_percentile":14080.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11973.8,"10th_percentile":1037.58,"90th_percentile":11976.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":14499.5,"10th_percentile":14499.5,"90th_percentile":14499.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"65","median_amount":1062.34,"10th_percentile":1037.58,"90th_percentile":11996.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11969.96,"10th_percentile":11969.96,"90th_percentile":11969.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":9385.5,"10th_percentile":1037.58,"90th_percentile":11492.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9746.12,"maximum":44987.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44987.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":12893.74},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":9746.12},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24558.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33551.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33551.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39686.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32893.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":15150.07,"10th_percentile":15150.07,"90th_percentile":15150.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2597.44,"10th_percentile":2597.44,"90th_percentile":2597.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":22852.0,"10th_percentile":22852.0,"90th_percentile":22852.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2736.74,"10th_percentile":2736.74,"90th_percentile":2736.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":29946.77,"10th_percentile":29946.77,"90th_percentile":29946.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14518.0,"maximum":27167.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27167.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14518.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20470.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20470.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23966.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20069.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1632.36,"10th_percentile":1632.36,"90th_percentile":15172.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":15354.49,"10th_percentile":15354.49,"90th_percentile":21052.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":23930.15,"10th_percentile":16546.65,"90th_percentile":25606.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1584.76,"10th_percentile":1533.17,"90th_percentile":18312.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"1 through 10","median_amount":18966.58,"10th_percentile":18966.58,"90th_percentile":18966.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1584.76,"10th_percentile":1584.76,"90th_percentile":1584.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"19","median_amount":11031.0,"10th_percentile":9801.87,"90th_percentile":33543.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1632.36,"10th_percentile":1632.36,"90th_percentile":1632.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"15","median_amount":1584.76,"10th_percentile":1584.76,"90th_percentile":1632.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":20663.82,"10th_percentile":20649.18,"90th_percentile":22230.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1573.22,"10th_percentile":1573.22,"90th_percentile":1573.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":22655.51,"10th_percentile":22655.51,"90th_percentile":22655.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"11","median_amount":1632.36,"10th_percentile":1584.76,"90th_percentile":18283.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10653.0,"maximum":22352.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22352.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10653.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16963.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16963.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19718.1},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16630.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1313.22,"10th_percentile":1313.22,"90th_percentile":1313.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":23806.4,"10th_percentile":2542.5,"90th_percentile":28504.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1313.22,"10th_percentile":1313.22,"90th_percentile":1313.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"33","median_amount":11226.0,"10th_percentile":8137.63,"90th_percentile":22581.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"1 through 10","median_amount":24105.46,"10th_percentile":24105.46,"90th_percentile":24105.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"13","median_amount":1313.22,"10th_percentile":1313.22,"90th_percentile":1333.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":17193.42,"10th_percentile":17178.78,"90th_percentile":17969.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":15142.46,"10th_percentile":15142.46,"90th_percentile":15142.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":18773.6,"10th_percentile":18773.6,"90th_percentile":18773.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3258.22,"10th_percentile":3258.22,"90th_percentile":3258.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1313.22,"10th_percentile":1313.22,"90th_percentile":1313.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc Or Insertion Of Antib","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29243.95,"maximum":38400.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38400.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29828.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29828.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33875.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29243.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15502.45,"maximum":20280.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20280.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15812.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15812.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17890.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15502.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1215.48,"10th_percentile":1215.48,"90th_percentile":1215.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8039.72,"maximum":10348.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10348.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8200.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8200.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9129.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8039.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":8508.99,"10th_percentile":8508.99,"90th_percentile":8508.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc Or Insertion Of Antibiotic-Eluting","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19894.0,"maximum":31011.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31011.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19894.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24003.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24003.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27356.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23533.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1858.29,"10th_percentile":1858.29,"90th_percentile":1858.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12882.0,"maximum":22180.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22180.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12882.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17087.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17087.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19566.95},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16752.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8947.0,"maximum":16891.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16891.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8947.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12916.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12916.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14901.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":999.93,"10th_percentile":999.93,"90th_percentile":999.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc Or Insertion Of Antibiotic-Eluting Bone Void Fi","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16141.0,"maximum":26608.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26608.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16141.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20235.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20235.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23472.78},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19839.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1657.04,"10th_percentile":1657.04,"90th_percentile":1657.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1657.04,"10th_percentile":1657.04,"90th_percentile":1657.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10117.0,"maximum":19381.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19381.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10117.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14553.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14553.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17097.86},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14268.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1126.67,"10th_percentile":1126.67,"90th_percentile":1126.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":10411.11,"10th_percentile":10411.11,"90th_percentile":10411.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":12093.45,"10th_percentile":12093.45,"90th_percentile":12093.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1126.67,"10th_percentile":1126.67,"90th_percentile":1126.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":41130.0,"10th_percentile":41130.0,"90th_percentile":41130.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1126.67,"10th_percentile":1126.67,"90th_percentile":12409.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":19319.01,"10th_percentile":19319.01,"90th_percentile":19319.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1980.0,"10th_percentile":1980.0,"90th_percentile":3351.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1126.67,"10th_percentile":1126.67,"90th_percentile":1817.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2100.0,"10th_percentile":2100.0,"90th_percentile":2100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8320.0,"maximum":14944.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14944.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8320.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11332.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11332.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13183.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11110.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":10111.19,"10th_percentile":10111.19,"90th_percentile":10111.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":893.82,"10th_percentile":893.82,"90th_percentile":893.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":20115.0,"10th_percentile":20115.0,"90th_percentile":20115.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":877.34,"10th_percentile":877.34,"90th_percentile":877.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":893.82,"10th_percentile":861.44,"90th_percentile":893.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18882.65,"maximum":26390.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26390.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19260.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19260.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23280.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18882.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1491.05,"10th_percentile":1491.05,"90th_percentile":1871.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1491.05,"10th_percentile":1491.05,"90th_percentile":1491.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1491.05,"10th_percentile":1491.05,"90th_percentile":1491.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"19","median_amount":11001.0,"10th_percentile":9622.73,"90th_percentile":15469.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1491.05,"10th_percentile":1491.05,"90th_percentile":16973.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":20526.86,"10th_percentile":19466.22,"90th_percentile":20637.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":17202.26,"10th_percentile":17202.26,"90th_percentile":17202.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1491.05,"10th_percentile":1491.05,"90th_percentile":17230.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21983.55,"maximum":29411.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29411.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22423.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25945.88},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21983.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14244.92,"maximum":19058.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19058.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14529.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14529.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16812.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14244.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1124.83,"10th_percentile":1124.83,"90th_percentile":1124.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":16372.0,"10th_percentile":16372.0,"90th_percentile":16372.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1124.83,"10th_percentile":1124.83,"90th_percentile":1124.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":18065.69,"10th_percentile":18065.69,"90th_percentile":18065.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":13013.01,"10th_percentile":13013.01,"90th_percentile":13013.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5093.99,"10th_percentile":5093.99,"90th_percentile":5093.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9429.0,"maximum":14274.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14274.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9429.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10882.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10882.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12592.25},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10669.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":3725.0,"10th_percentile":3725.0,"90th_percentile":3725.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":20030.0,"10th_percentile":20030.0,"90th_percentile":20030.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":13595.67,"10th_percentile":13595.67,"90th_percentile":13595.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7501.34,"maximum":20233.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20233.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":10402.55},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":7501.34},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10199.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12291.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12291.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17849.6},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12050.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":13893.03,"10th_percentile":13893.03,"90th_percentile":13893.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":15974.56,"10th_percentile":15974.56,"90th_percentile":15974.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":33523.68,"10th_percentile":33523.68,"90th_percentile":33523.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":13893.03,"10th_percentile":13893.03,"90th_percentile":13893.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1107.36,"10th_percentile":1107.36,"90th_percentile":1107.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7040.0,"maximum":11953.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11953.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7040.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10545.26},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":697.75,"10th_percentile":697.75,"90th_percentile":697.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":13824.56,"10th_percentile":13824.56,"90th_percentile":13824.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":697.75,"10th_percentile":697.75,"90th_percentile":697.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":11181.0,"10th_percentile":11181.0,"90th_percentile":11181.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":697.75,"10th_percentile":600.75,"90th_percentile":697.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":9317.7,"10th_percentile":9317.7,"90th_percentile":9317.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":697.75,"10th_percentile":697.75,"90th_percentile":6950.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc Or Insertion Of Antibioti","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15384.0,"maximum":33645.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33645.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15384.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25511.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25511.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29680.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25011.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1975.01,"10th_percentile":1975.01,"90th_percentile":1975.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7673.25,"maximum":23264.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23264.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":10157.95},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":7673.25},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9808.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17621.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17621.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20522.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17276.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1364.21,"10th_percentile":1364.21,"90th_percentile":12479.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":18087.09,"10th_percentile":18087.09,"90th_percentile":18087.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1174.1,"10th_percentile":1174.1,"90th_percentile":1174.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1364.21,"10th_percentile":1364.21,"90th_percentile":1364.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":17264.13,"10th_percentile":17264.13,"90th_percentile":17264.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":19502.61,"10th_percentile":19502.61,"90th_percentile":19502.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":15731.36,"10th_percentile":15731.36,"90th_percentile":15770.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6875.0,"maximum":18459.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18459.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6875.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13941.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13941.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16284.22},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13668.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":14842.97,"10th_percentile":14842.97,"90th_percentile":14842.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11497.48,"10th_percentile":11497.48,"90th_percentile":11497.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":22552.0,"10th_percentile":22552.0,"90th_percentile":22552.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":14204.25,"10th_percentile":14204.25,"90th_percentile":14204.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1062.28,"10th_percentile":1062.28,"90th_percentile":1062.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13265.92,"maximum":30404.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30404.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":17561.39},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":13265.92},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17667.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25192.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25192.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26821.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24698.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7236.85,"maximum":16205.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16205.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":9579.93},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":7236.85},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9864.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12534.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12534.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14295.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12288.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11127.61,"10th_percentile":11127.61,"90th_percentile":11127.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":34928.67,"10th_percentile":34928.67,"90th_percentile":35637.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without 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Plan","methodology":"fee schedule","standard_charge_dollar":8231.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":7236.85},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6261.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8395.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8395.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8231.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9418.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8231.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":649.97,"10th_percentile":649.97,"90th_percentile":649.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":9300.9,"10th_percentile":9300.9,"90th_percentile":9300.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":729.05,"10th_percentile":729.05,"90th_percentile":729.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":729.05,"10th_percentile":729.05,"90th_percentile":729.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":7496.62,"10th_percentile":7496.62,"90th_percentile":7496.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":756.46,"10th_percentile":756.46,"90th_percentile":7521.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20550.95,"maximum":29059.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29059.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20961.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20961.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25635.54},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20550.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1622.79,"10th_percentile":1622.79,"90th_percentile":1622.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11127.61,"10th_percentile":11127.61,"90th_percentile":11127.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1622.79,"10th_percentile":1622.79,"90th_percentile":1622.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":18724.31,"10th_percentile":18724.31,"90th_percentile":18724.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1622.79,"10th_percentile":1622.79,"90th_percentile":1622.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":16644.3,"10th_percentile":16644.3,"90th_percentile":16644.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13725.16,"maximum":19746.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19746.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17419.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue 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Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"1 through 10","median_amount":1508.79,"10th_percentile":1508.79,"90th_percentile":1508.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":8734.06,"10th_percentile":8734.06,"90th_percentile":8734.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17244.0,"maximum":30623.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30623.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17244.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21990.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21990.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27015.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21559.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8922.0,"maximum":17009.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17009.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8922.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12146.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12146.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15005.05},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11908.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":19795.1,"10th_percentile":19795.1,"90th_percentile":19795.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1005.55,"10th_percentile":1005.55,"90th_percentile":1005.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5810.0,"maximum":13061.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13061.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5810.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9351.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9351.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11522.12},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9168.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":723.98,"10th_percentile":723.98,"90th_percentile":723.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19013.44,"maximum":25296.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25296.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19393.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19393.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22315.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19013.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1452.51,"10th_percentile":1452.51,"90th_percentile":1452.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12733.3,"maximum":16178.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16178.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12987.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12987.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14271.8},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12733.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":8672.77,"10th_percentile":8672.77,"90th_percentile":8672.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":1543.0,"10th_percentile":1543.0,"90th_percentile":1543.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12212.85,"maximum":16178.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16178.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12457.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12457.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14271.8},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12212.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":10496.63,"10th_percentile":10496.63,"90th_percentile":10496.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":19884.43,"10th_percentile":19884.43,"90th_percentile":19884.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":964.38,"10th_percentile":964.38,"90th_percentile":964.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9190.98,"maximum":11067.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11067.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9374.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9374.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9762.97},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9190.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5685.23,"maximum":16921.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16921.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":7523.41},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":5685.23},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9555.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12551.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12551.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14927.87},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12305.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6202.0,"maximum":12422.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12422.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6202.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10522.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10958.52},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10316.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14122.26,"maximum":16008.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16008.74},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14122.26}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11103.0,"maximum":28510.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28510.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11103.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20987.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20987.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25150.73},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20576.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1624.78,"10th_percentile":1624.78,"90th_percentile":1624.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5545.28,"maximum":19300.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19300.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":7336.47},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":5545.28},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7454.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14448.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14448.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17026.31},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14165.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1118.54,"10th_percentile":1118.54,"90th_percentile":1118.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5292.0,"maximum":15525.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15525.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5292.0},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13696.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11276.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10724.4,"maximum":13860.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13860.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10938.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12227.23},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10724.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6964.08,"maximum":9293.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9293.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7103.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7103.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8198.39},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21709.7,"maximum":29066.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29066.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22143.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22143.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25641.17},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21709.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14156.37,"maximum":19303.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19303.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14439.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14439.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17028.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14156.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10468.26,"maximum":14334.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14334.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10677.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12645.31},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10468.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":826.62,"10th_percentile":826.62,"90th_percentile":826.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":826.62,"10th_percentile":826.62,"90th_percentile":826.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":841.03,"10th_percentile":841.03,"90th_percentile":841.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6941.52,"maximum":34002.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34002.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":9185.77},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":6941.52},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25968.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25968.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29995.63},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25459.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":16418.22,"10th_percentile":16418.22,"90th_percentile":16418.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":6169.5,"10th_percentile":6169.5,"90th_percentile":6709.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":26103.14,"10th_percentile":26103.14,"90th_percentile":26103.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13625.7,"maximum":18552.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18552.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13898.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13898.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16366.22},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13625.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":19155.72,"10th_percentile":19155.72,"90th_percentile":19155.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6775.12,"maximum":14177.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14177.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"fee schedule","standard_charge_dollar":8966.11},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":6775.12},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10380.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12507.02},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10176.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":11090.21,"10th_percentile":11090.21,"90th_percentile":11090.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19552.28,"maximum":25989.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25989.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19943.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19943.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22926.86},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19552.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":13181.62,"10th_percentile":13181.62,"90th_percentile":13181.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1543.93,"10th_percentile":1543.93,"90th_percentile":1543.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":740.0,"10th_percentile":740.0,"90th_percentile":740.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14426.13,"maximum":19282.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19282.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14714.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14714.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17010.23},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14426.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1139.14,"10th_percentile":1139.14,"90th_percentile":1139.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":5383.58,"10th_percentile":5383.58,"90th_percentile":5383.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1139.14,"10th_percentile":1139.14,"90th_percentile":1139.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"1 through 10","median_amount":11305.38,"10th_percentile":11305.38,"90th_percentile":11305.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"1 through 10","median_amount":11205.59,"10th_percentile":11205.59,"90th_percentile":11205.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1139.14,"10th_percentile":1139.14,"90th_percentile":12566.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1139.14,"10th_percentile":1139.14,"90th_percentile":1139.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1187.76,"10th_percentile":1139.14,"90th_percentile":2799.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical With Mcc","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":110455.93,"maximum":125210.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":125210.87},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":110455.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical With Cc","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":79050.89,"maximum":89610.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":89610.67},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":79050.89}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Or Complex Spinal Fusion Procedures Except Cervical Without Cc/Mcc","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58651.8,"maximum":66486.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":66486.63},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58651.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10679.44,"maximum":13345.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13345.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10893.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11772.97},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10679.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5491.29,"maximum":7653.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7653.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5601.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6751.99},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":433.61,"10th_percentile":433.61,"90th_percentile":433.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8733.2,"maximum":11596.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11596.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8907.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8907.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10230.1},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8733.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5501.51,"maximum":7353.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7353.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5611.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5611.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6486.67},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5501.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":434.42,"10th_percentile":434.42,"90th_percentile":434.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6500.85,"maximum":8337.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8337.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6630.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7354.99},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6500.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4906.8,"maximum":6487.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6487.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5004.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5722.87},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4906.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13417.93,"maximum":17659.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17659.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13686.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13686.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15578.3},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13417.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8830.61,"maximum":11916.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11916.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9007.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9007.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10512.3},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5363.9,"maximum":7558.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7558.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5471.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6667.57},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5363.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12033.69,"maximum":15683.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15683.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12274.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13835.23},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12033.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7002.91,"maximum":9166.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9166.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8086.63},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7002.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5140.46,"maximum":6748.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6748.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5952.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5140.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":826.62,"10th_percentile":826.62,"90th_percentile":826.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16905.76,"maximum":21785.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21785.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17243.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17243.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19218.01},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16905.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7857.15,"maximum":10695.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10695.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8014.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8014.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9434.94},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7857.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5696.33,"maximum":6859.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6859.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5810.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6050.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5696.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13153.61,"maximum":17782.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17782.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13416.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13416.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15686.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13153.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8223.65,"maximum":10417.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10417.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8388.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8388.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9189.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8223.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5954.52,"maximum":7834.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7834.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6073.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6073.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6911.18},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5954.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11417.87,"maximum":14901.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14901.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11646.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11646.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13145.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11417.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6548.54,"maximum":8733.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8733.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6679.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7703.93},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6548.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":517.1,"10th_percentile":517.1,"90th_percentile":517.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":517.1,"10th_percentile":517.1,"90th_percentile":517.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8830.61,"maximum":11385.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11385.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9007.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9007.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10043.57},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5654.78,"maximum":7590.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7590.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5767.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5767.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6695.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5654.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":6116.75,"10th_percentile":6116.75,"90th_percentile":6116.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9004.32,"maximum":11764.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11764.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9184.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10378.03},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9004.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5658.19,"maximum":7482.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7482.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5771.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5771.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6600.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5658.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10129.01,"maximum":13564.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13564.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10331.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11965.93},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10129.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6084.63,"maximum":8086.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8086.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6206.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7133.89},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6084.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":480.46,"10th_percentile":480.46,"90th_percentile":480.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12704.01,"maximum":16484.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16484.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12958.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14541.95},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12704.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7671.18,"maximum":10238.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10238.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7824.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7824.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9032.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7671.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":605.75,"10th_percentile":605.75,"90th_percentile":605.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":8672.77,"10th_percentile":8672.77,"90th_percentile":8672.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":14675.2,"10th_percentile":14675.2,"90th_percentile":14675.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":641.58,"10th_percentile":641.58,"90th_percentile":641.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1317.63,"10th_percentile":1317.63,"90th_percentile":1317.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":6981.12,"10th_percentile":6981.12,"90th_percentile":6981.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5476.3,"maximum":7526.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7526.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5585.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5585.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6639.43},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5476.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":8892.73,"10th_percentile":8892.73,"90th_percentile":8892.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":432.43,"10th_percentile":432.43,"90th_percentile":432.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9705.98,"maximum":12742.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12742.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9900.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9900.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11240.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":9287.86,"10th_percentile":9287.86,"90th_percentile":9287.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6100.3,"maximum":8186.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8186.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6222.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6222.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7221.53},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6100.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":503.59,"10th_percentile":503.59,"90th_percentile":503.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":503.59,"10th_percentile":503.59,"90th_percentile":503.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10515.26,"maximum":13588.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13588.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10725.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11986.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10515.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6637.78,"maximum":8913.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8913.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6770.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7863.12},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6637.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":6072.19,"10th_percentile":6072.19,"90th_percentile":6072.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5104.36,"maximum":6720.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6720.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5206.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5206.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5928.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5104.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20035.27,"maximum":26055.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26055.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20435.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22984.75},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20035.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11509.16,"maximum":14902.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14902.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11739.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13146.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11509.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7808.79,"maximum":10587.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10587.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7964.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7964.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9340.07},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7808.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44629.23,"maximum":57916.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57916.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45521.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45521.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51091.79},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44629.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23647.76,"maximum":32499.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32499.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24120.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24120.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28669.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23647.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12241.47,"maximum":17124.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17124.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12486.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15106.36},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12241.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33387.8,"maximum":45369.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45369.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34055.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34055.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40023.12},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33387.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2636.44,"10th_percentile":2636.44,"90th_percentile":2636.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18057.01,"maximum":25737.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25737.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18418.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18418.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22704.16},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18057.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10943.07,"maximum":15216.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15216.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11161.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13423.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10943.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22061.2,"maximum":29609.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29609.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22502.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26120.35},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22061.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11771.43,"maximum":15825.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15825.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12006.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12006.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13960.66},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11771.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9830.64,"maximum":13995.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13995.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10027.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10027.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12346.22},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9830.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":39004.0,"10th_percentile":39004.0,"90th_percentile":39004.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13124.32,"maximum":16417.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16417.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13386.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13386.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14483.26},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13124.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11746.9,"maximum":16417.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16417.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11981.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14483.26},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11746.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14582.81,"maximum":18494.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18494.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14874.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16314.77},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14582.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":300.0,"10th_percentile":300.0,"90th_percentile":300.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13141.35,"maximum":17240.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17240.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13404.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13404.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15208.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13141.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13183.59,"maximum":17406.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17406.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13447.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15355.6},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13183.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8081.27,"maximum":10549.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10549.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8242.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9306.3},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8081.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5904.79,"maximum":7109.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7109.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6022.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6022.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6272.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5904.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14446.56,"maximum":18437.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18437.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14735.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16264.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14446.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7374.17,"maximum":10086.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10086.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7521.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7521.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8897.87},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7374.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11356.56,"maximum":15844.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15844.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11583.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11583.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13977.54},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11356.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7706.61,"maximum":9986.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9986.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7860.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7860.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8809.43},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7706.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5241.28,"maximum":6311.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6311.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5346.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5346.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5567.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5241.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7095.55,"maximum":9087.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9087.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7237.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7237.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8016.68},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7095.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4121.36,"maximum":5481.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5481.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4203.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4203.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4835.26},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4121.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9682.13,"maximum":13007.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13007.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9875.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9875.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11474.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9682.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5932.72,"maximum":7868.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7868.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6051.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6940.93},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5932.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":468.47,"10th_percentile":468.47,"90th_percentile":468.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":1820.91,"10th_percentile":1820.91,"90th_percentile":1820.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":468.47,"10th_percentile":468.47,"90th_percentile":468.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10028.19,"maximum":13239.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13239.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10228.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10228.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11678.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10028.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6239.95,"maximum":8270.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8270.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6364.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6364.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7296.3},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6239.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":9064.7,"10th_percentile":9064.7,"90th_percentile":9064.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":153.92,"10th_percentile":153.92,"90th_percentile":153.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":520.44,"10th_percentile":520.44,"90th_percentile":520.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10308.17,"maximum":14328.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14328.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10514.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10514.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12639.68},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10308.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6174.55,"maximum":7994.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7994.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6298.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7052.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6174.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14930.91,"maximum":18505.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18505.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15229.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16324.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14930.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9532.27,"maximum":12405.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12405.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9722.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10943.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9532.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc Or Insertion Of","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23756.75,"maximum":28665.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28665.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24231.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24231.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25287.41},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23756.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12740.8,"maximum":15700.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15700.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12995.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12995.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13850.51},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9661.7,"maximum":11634.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11634.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9854.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9854.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10263.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9661.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19669.45,"maximum":23684.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23684.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20062.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20062.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20893.55},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19669.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10901.51,"maximum":14437.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14437.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11119.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12736.16},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10901.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10275.47,"maximum":14246.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14246.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10480.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10480.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12567.32},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10275.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24245.87,"maximum":34510.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34510.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24730.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24730.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30443.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24245.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12220.35,"maximum":18259.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18259.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12464.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12464.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16108.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12220.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8528.15,"maximum":12288.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12288.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8698.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10840.33},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8528.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20573.43,"maximum":28278.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28278.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20984.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24946.51},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20573.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10214.16,"maximum":14148.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14148.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10418.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10418.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12481.3},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10214.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9048.6,"maximum":12147.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12147.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9229.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9229.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10715.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9048.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc Or Insertion Of Antibiotic-Eluti","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25387.59,"maximum":33742.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33742.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25895.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25895.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29766.49},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25387.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14842.35,"maximum":19534.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19534.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15139.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15139.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17232.13},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14842.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":16371.96,"10th_percentile":16371.96,"90th_percentile":16371.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":26792.0,"10th_percentile":26792.0,"90th_percentile":26792.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1172.01,"10th_percentile":1172.01,"90th_percentile":1172.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9942.36,"maximum":12499.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12499.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10141.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10141.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11026.86},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9942.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9787.04,"maximum":12875.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12875.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9982.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11358.11},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9787.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":130.0,"10th_percentile":130.0,"90th_percentile":130.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6105.06,"maximum":8219.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8219.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6227.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6227.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7250.47},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6105.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":3194.52,"10th_percentile":3194.52,"90th_percentile":3194.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":8894.0,"10th_percentile":8894.0,"90th_percentile":8894.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":482.08,"10th_percentile":482.08,"90th_percentile":482.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4231.72,"maximum":5810.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5810.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5125.5},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4231.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":353.04,"10th_percentile":353.04,"90th_percentile":353.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":12800.6,"10th_percentile":12800.6,"90th_percentile":12800.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":334.15,"10th_percentile":334.15,"90th_percentile":334.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9098.33,"maximum":12205.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12205.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9280.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10767.17},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9098.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":721.12,"10th_percentile":721.12,"90th_percentile":721.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5301.23,"maximum":7167.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7167.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5407.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5407.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6322.66},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5301.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":440.26,"10th_percentile":440.26,"90th_percentile":440.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":440.26,"10th_percentile":440.26,"90th_percentile":440.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9687.58,"maximum":12054.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12054.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9881.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10633.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9687.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11213.51,"maximum":14708.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14708.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11437.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11437.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12974.95},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11213.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6982.47,"maximum":9154.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9154.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7122.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7122.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8075.38},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6982.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5233.79,"maximum":6799.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6799.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5338.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5338.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5998.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5233.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32026.72,"maximum":42763.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42763.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32667.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32667.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37724.48},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32026.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25244.53,"maximum":34340.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34340.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25749.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25749.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30293.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25244.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21999.9,"maximum":28977.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28977.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22439.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22439.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25562.38},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21999.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35398.75,"maximum":47523.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47523.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36106.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36106.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41922.97},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35398.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19069.3,"maximum":25697.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25697.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19450.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19450.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22669.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19069.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14418.63,"maximum":18722.89,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18722.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14707.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14707.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16516.57},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14418.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21688.58,"maximum":29877.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29877.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22122.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22122.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26356.73},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21688.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12466.27,"maximum":16737.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16737.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12715.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14765.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12466.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10571.12,"maximum":14028.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14028.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10782.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10782.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12375.17},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10571.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17309.04,"maximum":22237.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22237.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17655.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17655.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19616.8},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17309.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9003.64,"maximum":11863.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11863.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9183.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9183.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10465.67},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9003.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7053.32,"maximum":9512.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9512.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7194.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7194.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8391.35},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7053.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20855.45,"maximum":27786.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27786.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21272.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21272.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24512.35},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20855.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10355.86,"maximum":13920.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13920.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10562.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12280.3},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10355.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7131.66,"maximum":9522.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9522.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7274.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8400.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7131.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21262.14,"maximum":29634.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29634.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21687.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26142.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21262.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11916.52,"maximum":16451.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16451.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12154.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14513.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11916.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7535.62,"maximum":10303.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10303.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7686.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9089.22},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7535.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19891.53,"maximum":26174.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26174.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20289.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20289.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23090.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19891.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10572.48,"maximum":14196.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14196.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10783.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10783.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12523.91},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10572.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6657.53,"maximum":9388.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9388.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6790.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8282.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6657.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12227.84,"maximum":17940.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17940.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12472.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15826.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12227.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7353.73,"maximum":8855.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8855.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7500.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7500.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7811.66},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7353.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28622.0,"maximum":38755.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38755.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29194.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29194.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34188.49},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28622.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15930.94,"maximum":20510.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20510.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16249.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16249.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18093.22},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15930.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11181.49,"maximum":14482.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14482.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11405.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12775.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11181.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10088.82,"maximum":13360.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13360.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10290.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10290.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11785.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10088.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"1 through 10","median_amount":640.59,"10th_percentile":640.59,"90th_percentile":640.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":846.21,"10th_percentile":846.21,"90th_percentile":846.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5966.1,"maximum":7881.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7881.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6085.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6952.99},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5966.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4089.34,"maximum":5472.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5472.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4171.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4171.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4827.22},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4089.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":342.23,"10th_percentile":342.23,"90th_percentile":342.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12287.11,"maximum":15717.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15717.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12532.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12532.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13864.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12287.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7137.79,"maximum":9067.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9067.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7280.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7999.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7137.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5383.66,"maximum":6682.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6682.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5491.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5894.93},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5383.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7904.16,"maximum":10403.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10403.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8062.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8062.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9177.66},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7904.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":350.0,"10th_percentile":350.0,"90th_percentile":350.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5514.45,"maximum":7298.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7298.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5624.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5624.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6438.43},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5514.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":452.21,"10th_percentile":452.21,"90th_percentile":452.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9158.96,"maximum":11989.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11989.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9342.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9342.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10576.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9158.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5325.07,"maximum":7122.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7122.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6283.26},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5325.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7791.76,"maximum":10149.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10149.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7947.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8953.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7791.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4693.58,"maximum":6085.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6085.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4787.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5368.31},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4693.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7342.15,"maximum":8840.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8840.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7488.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7798.8},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7342.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11270.05,"maximum":14946.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14946.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11495.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11495.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13185.6},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11270.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6914.35,"maximum":9115.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9115.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7052.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8041.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6914.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4699.71,"maximum":6142.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6142.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4793.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4793.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5418.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4699.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13626.38,"maximum":18649.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18649.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13898.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13898.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16452.25},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13626.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10451.23,"maximum":13776.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13776.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10660.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12153.26},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10451.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15852.6,"maximum":19088.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19088.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16169.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16169.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16838.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15852.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9545.21,"maximum":13836.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13836.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9736.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12206.33},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9545.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14195.19,"maximum":17803.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17803.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14479.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14479.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15705.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14195.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7491.34,"maximum":9850.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9850.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7641.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7641.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8689.63},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7491.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10241.41,"maximum":14106.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14106.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10446.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10446.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12444.31},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10241.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7203.19,"maximum":10541.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10541.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7347.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9299.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7203.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Male Reproductive System And Other O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15240.86,"maximum":20867.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20867.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15545.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15545.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18408.38},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15240.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Male Reproductive System And Other O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10020.7,"maximum":13317.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13317.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10221.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10221.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11748.05},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10020.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12878.4,"maximum":17825.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17825.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13135.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13135.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15724.63},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12878.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9149.42,"maximum":12105.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12105.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9332.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10678.73},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9149.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12327.98,"maximum":15203.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15203.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12574.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12574.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13412.33},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7784.26,"maximum":9745.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9745.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7939.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7939.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8597.17},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7784.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4466.74,"maximum":5378.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5378.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4556.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4556.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4744.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4466.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7971.6,"maximum":10547.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10547.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8131.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9304.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7971.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4918.39,"maximum":6606.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6606.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5016.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5016.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5828.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4918.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10101.76,"maximum":12480.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12480.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10303.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10303.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11009.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10101.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5526.03,"maximum":7491.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7491.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5636.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5636.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6608.88},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5526.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7212.04,"maximum":9618.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9618.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7356.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7356.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8484.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7212.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4577.78,"maximum":6010.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6010.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4669.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4669.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5302.38},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4577.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy With Mcc","code_information":[{"code":"731","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28511.45,"maximum":32320.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32320.07},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28511.45}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy With Cc","code_information":[{"code":"732","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15436.8,"maximum":17498.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17498.88},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15436.8}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"733","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11511.67,"maximum":13049.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13049.43},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11511.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14509.92,"maximum":17471.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17471.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14800.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14800.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15412.68},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14509.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9165.77,"maximum":11037.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11037.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9349.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9736.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9165.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24350.09,"maximum":32577.99,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32577.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24837.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24837.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28738.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24350.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14037.15,"maximum":18780.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18780.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14317.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16567.22},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14037.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10003.67,"maximum":13383.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13383.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10203.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10203.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11806.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10003.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24406.63,"maximum":32653.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32653.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24894.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24894.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28805.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24406.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12327.3,"maximum":16492.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16492.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12573.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14549.18},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12327.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9714.83,"maximum":12997.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12997.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9909.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9909.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11465.84},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9714.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12498.97,"maximum":16813.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16813.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12748.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12748.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14832.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12498.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8451.86,"maximum":11819.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11819.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8620.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10427.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8451.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13958.81,"maximum":18793.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18793.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14237.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14237.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16579.28},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13958.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7748.84,"maximum":9710.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9710.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7903.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7903.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8566.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7748.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11833.42,"maximum":14810.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14810.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12070.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12070.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13065.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11833.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5856.42,"maximum":7902.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7902.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6971.48},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5856.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9450.52,"maximum":12580.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12580.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9639.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9639.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11098.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9450.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17490.92,"maximum":22517.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22517.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17840.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17840.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19863.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17490.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10053.4,"maximum":13620.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13620.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10254.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10254.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12015.78},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10053.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12545.97,"maximum":16477.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16477.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12796.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12796.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14535.52},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12545.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7410.28,"maximum":10468.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10468.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7558.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9234.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7410.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6543.09,"maximum":7879.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7879.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6673.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6673.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6950.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6543.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9754.34,"maximum":13345.63,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13345.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9949.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9949.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11772.97},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9754.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6669.11,"maximum":9025.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9025.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6802.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6802.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7962.01},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6669.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4520.55,"maximum":7005.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7005.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4610.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4610.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6180.35},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4520.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6863.26,"maximum":9227.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9227.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7000.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7000.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8140.5},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6863.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3886.34,"maximum":6415.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6415.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3964.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3964.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5659.36},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3886.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7299.92,"maximum":9575.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9575.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7445.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8446.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7299.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11511.2,"maximum":15189.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15189.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11741.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13399.46},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11511.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6830.56,"maximum":10013.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10013.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6967.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6967.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8833.55},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6830.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4459.93,"maximum":6122.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6122.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4549.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4549.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5401.27},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4459.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5731.08,"maximum":9294.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9294.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5845.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5845.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8199.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5731.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16724.55,"maximum":20483.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20483.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17059.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17059.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18069.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16724.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7221.58,"maximum":9522.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9522.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7366.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7366.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8400.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7221.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6524.69,"maximum":7992.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7992.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6655.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7050.28},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6524.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11236.67,"maximum":14918.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14918.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11461.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13160.68},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11236.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7607.83,"maximum":9906.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9906.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7759.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8738.68},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7607.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6531.51,"maximum":8318.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8318.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6662.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7338.11},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6531.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12276.89,"maximum":16620.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16620.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12522.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12522.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14661.74},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12276.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40488.12,"maximum":54813.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54813.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41297.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":48354.17},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40488.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27650.59,"maximum":37433.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37433.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28203.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28203.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33022.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27650.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16684.36,"maximum":22587.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22587.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17018.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17018.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19925.53},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16684.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28404.01,"maximum":38453.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38453.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28972.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33922.37},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28404.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10054.08,"maximum":13610.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13610.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10255.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12006.94},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10054.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1361.07,"maximum":1842.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1842.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1388.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1388.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":1625.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1361.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7949.8,"maximum":10762.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10762.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8108.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8108.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9494.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7949.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6814.89,"maximum":8934.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8934.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6951.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7881.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6814.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6519.93,"maximum":8426.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8426.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6650.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7433.78},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6519.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30851.63,"maximum":44164.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44164.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31468.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31468.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38960.23},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30851.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19138.1,"maximum":28698.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28698.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19520.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25316.35},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19138.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13003.75,"maximum":19985.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19985.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13263.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17630.11},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13003.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27140.36,"maximum":33723.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33723.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27683.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27683.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29749.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27140.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12663.14,"maximum":18024.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18024.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12916.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12916.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15900.71},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12663.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9237.3,"maximum":12958.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12958.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9422.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9422.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11431.27},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9237.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7351.69,"maximum":10299.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10299.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7498.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7498.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9086.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7351.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5136.37,"maximum":7190.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7190.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5239.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5239.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6342.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5136.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4592.76,"maximum":6199.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6199.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4684.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4684.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5468.81},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4592.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15040.58,"maximum":19782.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19782.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15341.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15341.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17451.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15040.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8623.52,"maximum":11177.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11177.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8795.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8795.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9860.26},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8623.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7129.61,"maximum":9796.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9796.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7272.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8642.2},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7129.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9566.33,"maximum":12751.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12751.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9757.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11248.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9566.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6254.93,"maximum":8418.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8418.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6380.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7426.55},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6254.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8368.47,"10th_percentile":8368.47,"90th_percentile":8368.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3248.15,"10th_percentile":3248.15,"90th_percentile":3248.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10390.6,"maximum":13925.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13925.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10598.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12284.32},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10390.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14487.44,"maximum":18890.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18890.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14777.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14777.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16664.51},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14487.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6907.54,"maximum":9519.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9519.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7045.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8397.78},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6907.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4305.29,"maximum":6724.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6724.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4391.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4391.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5931.91},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4305.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15542.64,"maximum":18714.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18714.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15853.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16509.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15542.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7896.66,"maximum":11789.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11789.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8054.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8054.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10400.54},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7896.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5857.78,"maximum":7053.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7053.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5974.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6222.16},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5857.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39952.0,"maximum":56920.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56920.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40751.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40751.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50213.02},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":39952.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15249.72,"maximum":20076.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20076.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15554.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17710.51},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15249.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8201.85,"maximum":10268.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10268.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8365.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8365.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9058.67},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8201.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31232.43,"maximum":41970.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41970.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31857.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31857.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37025.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31232.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15433.65,"maximum":20519.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20519.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15742.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18101.26},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15433.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9192.34,"maximum":11839.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11839.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9376.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10443.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9192.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31865.96,"maximum":43346.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43346.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32503.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32503.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38238.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31865.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15744.28,"maximum":21769.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21769.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16059.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16059.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19204.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15744.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11606.57,"maximum":15446.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15446.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11838.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11838.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13626.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11606.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21526.45,"maximum":28497.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28497.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21956.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21956.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25139.47},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21526.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8169.15,"maximum":10060.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10060.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8332.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8332.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8875.36},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8169.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":7442.44,"10th_percentile":7442.44,"90th_percentile":7442.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11196.48,"maximum":15015.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15015.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11420.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11420.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13245.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11196.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23354.84,"maximum":30551.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30551.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23821.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23821.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26950.88},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23354.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11676.06,"maximum":14709.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14709.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11909.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12975.76},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11676.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":9012.03,"10th_percentile":9012.03,"90th_percentile":9012.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16747.71,"maximum":22103.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22103.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17082.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17082.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19498.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16747.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31961.33,"maximum":43233.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43233.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32600.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32600.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38138.54},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31961.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8840.15,"maximum":12685.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12685.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9016.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9016.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11190.88},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8840.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6149.34,"maximum":7404.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7404.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6272.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6272.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6531.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6149.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8821.76,"maximum":12072.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12072.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8998.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8998.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10649.78},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8821.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":800.86,"10th_percentile":800.86,"90th_percentile":800.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19659.92,"maximum":27786.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27786.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20053.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20053.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24512.35},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19659.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":17909.61,"10th_percentile":17909.61,"90th_percentile":17909.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17966.41,"maximum":28668.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28668.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18325.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18325.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25289.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17966.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41699.32,"maximum":65387.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":65387.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":42533.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":57682.18},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41699.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6406.84,"maximum":9163.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9163.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6534.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8083.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6406.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10440.33,"maximum":13644.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13644.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10649.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10649.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12036.68},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10440.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18623.1,"maximum":24025.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24025.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18995.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18995.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21194.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18623.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20055.7,"maximum":24710.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24710.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21798.85},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20055.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28705.79,"maximum":37139.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37139.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29279.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29279.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32763.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28705.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51908.04,"maximum":68812.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68812.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52946.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52946.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":60703.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":51908.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25634.19,"maximum":34914.82,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34914.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26146.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26146.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30800.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25634.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45853.38,"maximum":59475.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59475.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46770.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46770.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52466.63},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":45853.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3787.57,"maximum":5080.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5080.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3863.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3863.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4481.5},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3787.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":865.46,"10th_percentile":865.46,"90th_percentile":865.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4276.0,"maximum":6982.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6982.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4361.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4361.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6159.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4276.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8104.44,"maximum":10235.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10235.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8266.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8266.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9029.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8104.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5453.14,"maximum":7139.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7139.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5562.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5562.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6297.73},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5453.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8647.37,"maximum":11490.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11490.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8820.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8820.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10136.83},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8647.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":682.83,"10th_percentile":682.83,"90th_percentile":682.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7812.19,"maximum":10067.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10067.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7968.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7968.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8880.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7812.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10549.32,"maximum":13436.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13436.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10760.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11853.37},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10549.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13813.03,"maximum":17716.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17716.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14089.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15628.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13813.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15919.35,"maximum":19242.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19242.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16237.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16237.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16974.85},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15919.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1189.62,"10th_percentile":1189.62,"90th_percentile":1189.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26328.35,"maximum":33542.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33542.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26854.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26854.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29589.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26328.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6970.89,"maximum":9174.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9174.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7110.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7110.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8093.06},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6970.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":550.45,"10th_percentile":550.45,"90th_percentile":550.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":5542.49,"10th_percentile":5542.49,"90th_percentile":5542.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":5200.97,"10th_percentile":5200.97,"90th_percentile":5200.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":485.72,"10th_percentile":485.72,"90th_percentile":485.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"1 through 10","median_amount":12570.08,"10th_percentile":12570.08,"90th_percentile":12570.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2100.0,"10th_percentile":2100.0,"90th_percentile":2100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13232.64,"maximum":17608.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17608.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13497.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13497.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15533.28},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13232.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12022.67,"10th_percentile":12022.67,"90th_percentile":12022.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1044.91,"10th_percentile":1044.91,"90th_percentile":1044.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1044.91,"10th_percentile":1044.91,"90th_percentile":1105.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":234.64,"10th_percentile":234.64,"90th_percentile":234.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":12060.0,"10th_percentile":1044.91,"90th_percentile":12087.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47084.34,"maximum":63280.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":63280.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48026.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48026.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55823.33},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":47084.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4970.84,"maximum":6182.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6182.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5070.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5070.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5454.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4970.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7024.03,"maximum":9323.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9323.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7164.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7164.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8224.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7024.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14259.23,"maximum":19918.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19918.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14544.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14544.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17571.42},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14259.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5923.86,"maximum":7920.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7920.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6042.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6042.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6987.56},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5923.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10206.67,"maximum":12290.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12290.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10410.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10841.94},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10206.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6047.16,"maximum":7795.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7795.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6168.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6168.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6876.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6047.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6797.86,"maximum":8993.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8993.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6933.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6933.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7933.87},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6797.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":5871.0,"10th_percentile":5871.0,"90th_percentile":5871.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":7673.85,"10th_percentile":7673.85,"90th_percentile":7673.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":563.37,"10th_percentile":563.37,"90th_percentile":563.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12423.35,"maximum":16323.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16323.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12671.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14399.64},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12423.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9488.67,"maximum":12786.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12786.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9678.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9678.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11280.12},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9488.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":7049.18,"10th_percentile":7049.18,"90th_percentile":7049.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":14393.02,"10th_percentile":14393.02,"90th_percentile":14393.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":749.26,"10th_percentile":749.26,"90th_percentile":749.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":749.26,"10th_percentile":749.26,"90th_percentile":749.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14588.26,"maximum":19760.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19760.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14880.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14880.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17432.33},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14588.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12694.89,"10th_percentile":12694.89,"90th_percentile":12694.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1151.95,"10th_percentile":1151.95,"90th_percentile":1151.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":21028.07,"10th_percentile":21028.07,"90th_percentile":21028.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1227.66,"10th_percentile":1227.66,"90th_percentile":1227.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":17489.75,"10th_percentile":17489.75,"90th_percentile":17489.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1763.84,"10th_percentile":1763.84,"90th_percentile":1763.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1151.95,"10th_percentile":1151.95,"90th_percentile":1151.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30986.51,"maximum":40850.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40850.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31606.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":31606.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36036.89},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30986.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2446.82,"10th_percentile":2446.82,"90th_percentile":2446.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":2446.82,"10th_percentile":2446.82,"90th_percentile":2446.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":18637.18,"10th_percentile":18637.18,"90th_percentile":18637.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10199.18,"maximum":13218.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13218.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10403.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10403.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11661.22},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10199.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13611.39,"maximum":18311.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18311.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13883.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13883.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16153.97},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13611.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":12570.08,"10th_percentile":12570.08,"90th_percentile":12570.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33642.57,"maximum":44937.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44937.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34315.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":34315.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39642.02},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33642.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58989.97,"maximum":76626.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76626.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60169.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":60169.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":67597.1},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":58989.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18457.57,"maximum":23556.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23556.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18826.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18826.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20780.18},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18457.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5786.26,"maximum":7065.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7065.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5901.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5901.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6232.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5786.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8911.68,"maximum":12289.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12289.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9089.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10841.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8911.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17660.54,"maximum":23050.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23050.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18013.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18013.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20333.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17660.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5801.24,"maximum":7694.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7694.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5917.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6788.17},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5801.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8293.13,"maximum":11448.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11448.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8458.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10099.04},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13588.91,"maximum":17728.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17728.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13860.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13860.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15639.41},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13588.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6883.01,"maximum":9066.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9066.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7020.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7020.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7998.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6883.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11113.37,"maximum":14370.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14370.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11335.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11335.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12676.67},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11113.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22036.68,"maximum":29836.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29836.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22477.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22477.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26320.55},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22036.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9836.09,"maximum":12555.45,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12555.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10032.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10032.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11075.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14219.72,"maximum":19664.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19664.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14504.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14504.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17347.1},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14219.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32727.7,"maximum":42930.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42930.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33382.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33382.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37871.62},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32727.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8307.44,"maximum":10390.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10390.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8473.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9166.4},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8307.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14208.82,"maximum":20992.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20992.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14493.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14493.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18518.53},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14208.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37398.12,"maximum":50197.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50197.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38146.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":38146.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44281.91},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37398.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3562.08,"maximum":4557.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4557.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3633.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3633.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":4020.0},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3562.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4915.66,"maximum":6910.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6910.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5013.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5013.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6095.93},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4915.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8191.63,"maximum":10529.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10529.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8355.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8355.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9288.61},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8191.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10252.31,"maximum":13536.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13536.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10457.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10457.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11941.01},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10252.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24717.95,"maximum":29763.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29763.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25212.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25212.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26256.23},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24717.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14033.07,"maximum":22085.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22085.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14313.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14313.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19482.53},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14033.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15058.98,"maximum":18132.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18132.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15360.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15360.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15995.58},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15058.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26527.94,"maximum":31942.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31942.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27058.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27058.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28178.59},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26527.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21940.63,"maximum":27506.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27506.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22379.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22379.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24264.72},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21940.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":48861.63,"maximum":69671.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69671.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49838.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":49838.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61460.98},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":48861.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":145443.18,"maximum":253675.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":253675.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148352.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":148352.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":223782.14},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":145443.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6932.74,"maximum":9095.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9095.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7071.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7071.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8023.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6932.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":5846.0,"10th_percentile":5846.0,"90th_percentile":5846.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11917.21,"maximum":14808.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14808.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12155.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12155.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13063.39},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11917.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4689.5,"maximum":6123.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6123.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4783.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4783.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5402.08},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4689.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":370.3,"10th_percentile":370.3,"90th_percentile":370.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":6605.24,"10th_percentile":6605.24,"90th_percentile":6605.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":17892.0,"10th_percentile":17892.0,"90th_percentile":17892.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":370.3,"10th_percentile":370.3,"90th_percentile":370.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6827.84,"maximum":9091.22,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9091.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6964.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8019.9},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6827.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":13990.0,"10th_percentile":13990.0,"90th_percentile":13990.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":539.16,"10th_percentile":539.16,"90th_percentile":539.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":1046.0,"10th_percentile":1046.0,"90th_percentile":1046.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12471.72,"maximum":16062.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16062.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12721.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14169.7},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12471.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5838.71,"maximum":7943.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7943.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5955.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7007.66},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5838.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":498.41,"10th_percentile":498.41,"90th_percentile":498.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10684.2,"maximum":14307.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14307.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10897.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10897.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12621.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10684.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4538.95,"maximum":6312.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6312.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4629.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4629.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5568.5},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4538.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11455.34,"maximum":15091.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15091.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11684.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13313.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11455.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6032.17,"maximum":8458.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8458.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6152.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7461.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6032.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11135.17,"maximum":14079.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14079.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11357.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12420.19},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11135.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8942.33,"maximum":12586.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12586.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9121.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9121.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11103.24},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8942.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":6610.13,"10th_percentile":6610.13,"90th_percentile":6610.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"1 through 10","median_amount":10094.66,"10th_percentile":10094.66,"90th_percentile":10094.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":714.6,"10th_percentile":714.6,"90th_percentile":714.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13591.64,"maximum":17844.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17844.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13863.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15741.52},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13591.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":600.8,"10th_percentile":600.8,"90th_percentile":600.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1095.32,"10th_percentile":1095.32,"90th_percentile":1095.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":34025.0,"10th_percentile":34025.0,"90th_percentile":46485.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":1136.49,"10th_percentile":1136.49,"90th_percentile":1136.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"1 through 10","median_amount":12411.21,"10th_percentile":12411.21,"90th_percentile":12411.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26153.96,"maximum":35509.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35509.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26677.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26677.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31325.45},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26153.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13381.14,"maximum":16112.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16112.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13648.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14213.92},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13381.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10105.17,"maximum":14164.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14164.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10307.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10307.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12494.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10105.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25021.77,"maximum":33808.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33808.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25522.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29824.38},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25021.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7967.51,"maximum":10242.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10242.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8126.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9035.35},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7967.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13041.89,"maximum":17260.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17260.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13302.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13302.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15226.15},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13041.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"1 through 10","median_amount":3004.01,"10th_percentile":3004.01,"90th_percentile":3004.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28587.94,"maximum":40776.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40776.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29159.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35970.96},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28587.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"1 through 10","median_amount":12018.0,"10th_percentile":12018.0,"90th_percentile":12018.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6013.78,"maximum":7824.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7824.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6134.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6134.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6902.34},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6013.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11887.91,"maximum":15138.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15138.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12125.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12125.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13354.44},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11887.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9643.3,"maximum":12996.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12996.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9836.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11465.04},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9643.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4202.43,"maximum":5716.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5716.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4286.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4286.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":5042.69},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4202.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7295.15,"maximum":10165.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10165.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7441.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7441.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8967.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14137.29,"maximum":17023.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17023.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14420.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14420.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15017.11},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14137.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9515.24,"maximum":12672.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12672.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9705.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11178.82},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9515.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10960.1,"maximum":14580.58,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14580.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11179.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11179.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12862.39},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10960.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13394.77,"maximum":16129.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16129.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14228.39},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13394.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7314.91,"maximum":9071.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9071.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7461.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7461.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8002.21},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7314.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6409.57,"maximum":8168.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8168.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6537.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6537.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7206.25},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6409.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6541.04,"maximum":8481.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8481.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6671.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6671.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7482.02},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6541.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17388.5,"maximum":54687.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":17388.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54687.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17388.5,"maximum":38914.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":17388.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38914.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17388.5,"maximum":28651.0,"payers_information":[{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"fee schedule","standard_charge_dollar":17388.5},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28651.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33166.0,"maximum":33166.0,"payers_information":[{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":33166.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19819.0,"maximum":19819.0,"payers_information":[{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19819.0}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":3384.51,"10th_percentile":3384.51,"90th_percentile":3384.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":15.6,"10th_percentile":15.6,"90th_percentile":15.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":885.0,"10th_percentile":885.0,"90th_percentile":885.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"14","median_amount":1146.53,"10th_percentile":1146.53,"90th_percentile":1719.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"28","median_amount":485.5,"10th_percentile":485.5,"90th_percentile":728.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":50.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":638.96,"10th_percentile":638.96,"90th_percentile":648.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":849.0,"10th_percentile":849.0,"90th_percentile":849.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":135.25,"10th_percentile":135.25,"90th_percentile":135.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":114.78,"10th_percentile":114.78,"90th_percentile":114.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":113.73,"10th_percentile":113.73,"90th_percentile":113.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":341.25,"10th_percentile":341.25,"90th_percentile":341.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":56.88,"10th_percentile":56.88,"90th_percentile":73.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"53","median_amount":65.72,"10th_percentile":62.71,"90th_percentile":65.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":280.45,"10th_percentile":272.28,"90th_percentile":341.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":79.42,"10th_percentile":79.42,"90th_percentile":79.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":341.25,"10th_percentile":341.25,"90th_percentile":341.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":80.02,"10th_percentile":80.02,"90th_percentile":80.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"42","median_amount":178.6,"10th_percentile":148.44,"90th_percentile":341.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":152.0,"10th_percentile":152.0,"90th_percentile":152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":152.0,"10th_percentile":152.0,"90th_percentile":152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":73.5,"10th_percentile":73.5,"90th_percentile":73.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":60.0,"10th_percentile":60.0,"90th_percentile":341.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":78.42,"10th_percentile":78.42,"90th_percentile":78.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":79.0,"10th_percentile":79.0,"90th_percentile":79.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"17","median_amount":73.14,"10th_percentile":73.14,"90th_percentile":160.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":407.0,"10th_percentile":407.0,"90th_percentile":407.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":143.24,"10th_percentile":143.24,"90th_percentile":341.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"19","median_amount":118.17,"10th_percentile":114.19,"90th_percentile":183.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":272.28,"10th_percentile":272.28,"90th_percentile":691.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":142.04,"10th_percentile":142.04,"90th_percentile":142.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":133.76,"10th_percentile":133.76,"90th_percentile":133.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"41","median_amount":190.44,"10th_percentile":133.24,"90th_percentile":261.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":152.0,"10th_percentile":152.0,"90th_percentile":152.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":143.92,"10th_percentile":143.92,"90th_percentile":143.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":60.0,"10th_percentile":60.0,"90th_percentile":203.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":133.12,"10th_percentile":133.12,"90th_percentile":133.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":136.0,"10th_percentile":136.0,"90th_percentile":479.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"17","median_amount":141.75,"10th_percentile":132.82,"90th_percentile":167.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"28","median_amount":594.0,"10th_percentile":576.35,"90th_percentile":594.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"68","median_amount":240.33,"10th_percentile":138.81,"90th_percentile":285.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"403","median_amount":209.02,"10th_percentile":203.02,"90th_percentile":432.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"163","median_amount":595.17,"10th_percentile":272.28,"90th_percentile":711.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"12","median_amount":246.61,"10th_percentile":233.03,"90th_percentile":273.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"28","median_amount":538.23,"10th_percentile":212.13,"90th_percentile":538.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":235.78,"10th_percentile":235.78,"90th_percentile":325.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"587","median_amount":178.63,"10th_percentile":125.86,"90th_percentile":340.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"62","median_amount":362.0,"10th_percentile":362.0,"90th_percentile":362.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":234.33,"10th_percentile":234.33,"90th_percentile":234.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":240.15,"10th_percentile":240.15,"90th_percentile":433.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":254.34,"10th_percentile":253.74,"90th_percentile":434.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":362.0,"10th_percentile":362.0,"90th_percentile":362.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":313.8,"10th_percentile":251.64,"90th_percentile":331.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"73","median_amount":60.0,"10th_percentile":60.0,"90th_percentile":169.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"29","median_amount":249.11,"10th_percentile":234.64,"90th_percentile":342.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"45","median_amount":214.0,"10th_percentile":214.0,"90th_percentile":214.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"161","median_amount":248.81,"10th_percentile":234.34,"90th_percentile":331.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1294.96,"10th_percentile":1294.96,"90th_percentile":1294.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":240.15,"10th_percentile":240.15,"90th_percentile":299.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"73","median_amount":874.0,"10th_percentile":874.0,"90th_percentile":874.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"180","median_amount":389.25,"10th_percentile":248.81,"90th_percentile":703.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"875","median_amount":369.09,"10th_percentile":309.27,"90th_percentile":716.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":212.63,"10th_percentile":212.63,"90th_percentile":212.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"302","median_amount":691.24,"10th_percentile":272.28,"90th_percentile":1099.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"39","median_amount":361.69,"10th_percentile":233.69,"90th_percentile":608.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"74","median_amount":538.23,"10th_percentile":212.13,"90th_percentile":892.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"37","median_amount":382.35,"10th_percentile":359.63,"90th_percentile":688.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1292","median_amount":257.55,"10th_percentile":152.39,"90th_percentile":621.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"152","median_amount":362.0,"10th_percentile":362.0,"90th_percentile":788.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":447.2,"10th_percentile":445.87,"90th_percentile":447.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"30","median_amount":414.96,"10th_percentile":240.15,"90th_percentile":881.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":391.04,"10th_percentile":391.04,"90th_percentile":593.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":212.13,"10th_percentile":162.75,"90th_percentile":1281.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"23","median_amount":518.32,"10th_percentile":363.71,"90th_percentile":630.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"70","median_amount":60.0,"10th_percentile":60.0,"90th_percentile":358.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"52","median_amount":437.28,"10th_percentile":235.95,"90th_percentile":790.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"137","median_amount":214.0,"10th_percentile":214.0,"90th_percentile":343.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"405","median_amount":381.46,"10th_percentile":178.16,"90th_percentile":763.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":890.16,"10th_percentile":595.89,"90th_percentile":7793.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":272.13,"10th_percentile":272.13,"90th_percentile":934.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"19","median_amount":1122.99,"10th_percentile":255.62,"90th_percentile":1209.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"44","median_amount":657.28,"10th_percentile":110.0,"90th_percentile":1184.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"179","median_amount":774.64,"10th_percentile":524.46,"90th_percentile":1975.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"75","median_amount":691.24,"10th_percentile":272.28,"90th_percentile":2089.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":695.32,"10th_percentile":579.9,"90th_percentile":1197.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"16","median_amount":892.18,"10th_percentile":212.13,"90th_percentile":1578.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"15","median_amount":828.55,"10th_percentile":519.1,"90th_percentile":1073.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"284","median_amount":530.26,"10th_percentile":254.38,"90th_percentile":923.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"31","median_amount":788.0,"10th_percentile":788.0,"90th_percentile":788.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":829.14,"10th_percentile":724.46,"90th_percentile":1054.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":996.46,"10th_percentile":996.46,"90th_percentile":996.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":718.17,"10th_percentile":718.17,"90th_percentile":1027.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1158.82,"10th_percentile":1158.82,"90th_percentile":1240.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"13","median_amount":60.0,"10th_percentile":60.0,"90th_percentile":834.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"20","median_amount":889.7,"10th_percentile":125.0,"90th_percentile":2237.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"35","median_amount":343.0,"10th_percentile":343.0,"90th_percentile":507.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"103","median_amount":831.6,"10th_percentile":405.0,"90th_percentile":1394.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":542.32,"10th_percentile":542.32,"90th_percentile":546.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1620.2,"10th_percentile":1620.2,"90th_percentile":1620.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1172.15,"10th_percentile":1172.15,"90th_percentile":1172.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1094.99,"10th_percentile":1094.99,"90th_percentile":1094.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":1992.2,"10th_percentile":1992.2,"90th_percentile":1992.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":959.15,"10th_percentile":959.15,"90th_percentile":959.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":874.0,"10th_percentile":594.0,"90th_percentile":3836.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":721.05,"10th_percentile":721.05,"90th_percentile":721.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":264.73,"10th_percentile":264.73,"90th_percentile":281.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":136.0,"10th_percentile":136.0,"90th_percentile":136.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":176.97,"10th_percentile":176.97,"90th_percentile":176.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":169.05,"10th_percentile":169.05,"90th_percentile":169.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":441.75,"10th_percentile":441.75,"90th_percentile":441.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1875.64,"10th_percentile":1875.64,"90th_percentile":1875.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":637.24,"10th_percentile":637.24,"90th_percentile":637.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":892.18,"10th_percentile":892.18,"90th_percentile":892.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1047.54,"10th_percentile":1047.54,"90th_percentile":1047.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":343.0,"10th_percentile":343.0,"90th_percentile":343.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1660.43,"10th_percentile":1660.43,"90th_percentile":1827.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1549.23,"10th_percentile":1549.23,"90th_percentile":1549.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":2457.97,"10th_percentile":2457.97,"90th_percentile":2457.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1662.4,"10th_percentile":1662.4,"90th_percentile":1662.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":1131.0,"10th_percentile":1131.0,"90th_percentile":1131.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2245.94,"10th_percentile":2245.94,"90th_percentile":2245.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Skin Procedures","code_information":[{"code":"5055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2635.51,"10th_percentile":2635.51,"90th_percentile":2635.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":843.17,"10th_percentile":843.17,"90th_percentile":843.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":379.2,"10th_percentile":379.2,"90th_percentile":379.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1448.91,"10th_percentile":1448.91,"90th_percentile":1448.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":4639.88,"10th_percentile":4639.88,"90th_percentile":4639.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1446.02,"10th_percentile":1446.02,"90th_percentile":1446.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":1555.86,"10th_percentile":1555.86,"90th_percentile":1998.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":2682.5,"10th_percentile":2682.5,"90th_percentile":2682.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":1895.99,"10th_percentile":1895.99,"90th_percentile":1895.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2556.95,"10th_percentile":2556.95,"90th_percentile":2556.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2183.95,"10th_percentile":2183.95,"90th_percentile":2183.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":5116.34,"10th_percentile":5116.34,"90th_percentile":5116.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2556.61,"10th_percentile":2556.61,"90th_percentile":2556.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":2391.49,"10th_percentile":2391.49,"90th_percentile":2559.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":1024.0,"10th_percentile":1024.0,"90th_percentile":1024.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2601.03,"10th_percentile":2601.03,"90th_percentile":2692.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":2286.0,"10th_percentile":2286.0,"90th_percentile":2286.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2549.01,"10th_percentile":2491.03,"90th_percentile":2591.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2508.58,"10th_percentile":2508.58,"90th_percentile":2508.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":3976.98,"10th_percentile":3976.98,"90th_percentile":3976.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":1896.0,"10th_percentile":1896.0,"90th_percentile":2338.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"14","median_amount":1376.29,"10th_percentile":1369.15,"90th_percentile":1432.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1194.35,"10th_percentile":1194.35,"90th_percentile":1197.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"21","median_amount":2457.97,"10th_percentile":1146.53,"90th_percentile":2768.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1427.26,"10th_percentile":1427.26,"90th_percentile":1533.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":1912.87,"10th_percentile":1912.87,"90th_percentile":2091.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1376.19,"10th_percentile":1376.19,"90th_percentile":1430.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"26","median_amount":2230.36,"10th_percentile":437.9,"90th_percentile":3539.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":893.0,"10th_percentile":893.0,"90th_percentile":1024.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1401.62,"10th_percentile":1401.62,"90th_percentile":1401.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":531.17,"10th_percentile":531.17,"90th_percentile":531.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1434.27,"10th_percentile":1431.97,"90th_percentile":1447.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":2286.0,"10th_percentile":1566.72,"90th_percentile":2286.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"22","median_amount":1426.67,"10th_percentile":1368.76,"90th_percentile":1455.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1372.85,"10th_percentile":1372.85,"90th_percentile":1372.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":3273.0,"10th_percentile":2182.0,"90th_percentile":4805.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2843.65,"10th_percentile":2790.33,"90th_percentile":4075.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"22","median_amount":2433.43,"10th_percentile":2421.39,"90th_percentile":2535.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"32","median_amount":3410.89,"10th_percentile":3410.89,"90th_percentile":5952.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2909.73,"10th_percentile":2889.73,"90th_percentile":2996.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":6048.14,"10th_percentile":6048.14,"90th_percentile":6048.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2895.03,"10th_percentile":2891.45,"90th_percentile":2895.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"42","median_amount":2775.22,"10th_percentile":2203.52,"90th_percentile":3539.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":2225.5,"10th_percentile":1838.0,"90th_percentile":5611.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"33","median_amount":2852.07,"10th_percentile":2852.07,"90th_percentile":2948.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1341.19,"10th_percentile":1341.19,"90th_percentile":1341.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2898.65,"10th_percentile":2898.65,"90th_percentile":2898.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"19","median_amount":2588.0,"10th_percentile":2588.0,"90th_percentile":4141.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"23","median_amount":2916.73,"10th_percentile":2791.03,"90th_percentile":3123.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2913.48,"10th_percentile":2897.23,"90th_percentile":6175.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":2773.48,"10th_percentile":2773.48,"90th_percentile":2773.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"20","median_amount":6369.98,"10th_percentile":6177.47,"90th_percentile":7072.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"35","median_amount":5450.16,"10th_percentile":5331.22,"90th_percentile":5667.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"77","median_amount":5342.14,"10th_percentile":2457.97,"90th_percentile":10359.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"17","median_amount":6369.98,"10th_percentile":6169.97,"90th_percentile":10913.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":377.09,"10th_percentile":377.09,"90th_percentile":377.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":6548.86,"10th_percentile":6294.87,"90th_percentile":11462.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"116","median_amount":5511.86,"10th_percentile":4587.23,"90th_percentile":8688.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"16","median_amount":6788.38,"10th_percentile":1352.0,"90th_percentile":10276.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":11467.0,"10th_percentile":11467.0,"90th_percentile":11467.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"52","median_amount":6324.95,"10th_percentile":6324.95,"90th_percentile":6583.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"14","median_amount":2656.36,"10th_percentile":2183.46,"90th_percentile":3553.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":6365.74,"10th_percentile":6175.98,"90th_percentile":7102.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"32","median_amount":4537.5,"10th_percentile":3467.5,"90th_percentile":8360.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"84","median_amount":6369.68,"10th_percentile":6177.18,"90th_percentile":6710.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":6362.38,"10th_percentile":6175.37,"90th_percentile":6931.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":6492.9,"10th_percentile":6492.9,"90th_percentile":6492.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":15665.16,"10th_percentile":2727.94,"90th_percentile":19635.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"111","median_amount":11576.06,"10th_percentile":11064.49,"90th_percentile":12000.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"75","median_amount":9817.74,"10th_percentile":9643.56,"90th_percentile":10464.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"152","median_amount":13135.89,"10th_percentile":10813.67,"90th_percentile":15900.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"82","median_amount":11581.67,"10th_percentile":11110.73,"90th_percentile":12018.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":8859.53,"10th_percentile":6714.33,"90th_percentile":11988.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":11552.59,"10th_percentile":11057.92,"90th_percentile":16473.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"78","median_amount":9342.21,"10th_percentile":9224.98,"90th_percentile":15924.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"37","median_amount":11986.21,"10th_percentile":10588.1,"90th_percentile":14189.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"20","median_amount":11066.07,"10th_percentile":390.28,"90th_percentile":11648.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":11381.39,"10th_percentile":9095.58,"90th_percentile":11863.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":11695.21,"10th_percentile":11233.62,"90th_percentile":11854.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1333.86,"10th_percentile":1333.86,"90th_percentile":1333.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"135","median_amount":11678.78,"10th_percentile":11282.92,"90th_percentile":11784.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":2400.66,"10th_percentile":2400.66,"90th_percentile":2400.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"38","median_amount":11524.02,"10th_percentile":11150.78,"90th_percentile":12066.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"35","median_amount":4297.0,"10th_percentile":4297.0,"90th_percentile":9325.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"191","median_amount":11604.4,"10th_percentile":11120.17,"90th_percentile":12068.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"15","median_amount":11658.6,"10th_percentile":10974.97,"90th_percentile":11870.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":11556.19,"10th_percentile":11556.19,"90th_percentile":11668.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":18331.79,"10th_percentile":16195.24,"90th_percentile":18818.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"28","median_amount":16406.22,"10th_percentile":15003.57,"90th_percentile":16756.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":13040.1,"10th_percentile":9732.55,"90th_percentile":14137.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":17164.74,"10th_percentile":3380.11,"90th_percentile":26832.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"16","median_amount":16380.86,"10th_percentile":14995.57,"90th_percentile":16749.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":12872.17,"10th_percentile":12872.17,"90th_percentile":12872.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":16474.4,"10th_percentile":14982.54,"90th_percentile":17097.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"20","median_amount":10276.16,"10th_percentile":1307.76,"90th_percentile":15086.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":15708.0,"10th_percentile":13437.46,"90th_percentile":33255.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":16386.46,"10th_percentile":16386.46,"90th_percentile":16386.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":42419.06,"10th_percentile":42419.06,"90th_percentile":42419.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"23","median_amount":16712.88,"10th_percentile":15375.48,"90th_percentile":16877.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":15601.2,"10th_percentile":14912.64,"90th_percentile":17154.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":7900.0,"10th_percentile":7417.05,"90th_percentile":9068.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"44","median_amount":16471.52,"10th_percentile":15074.77,"90th_percentile":16914.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":17847.17,"10th_percentile":17847.17,"90th_percentile":17932.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":14965.28,"10th_percentile":14965.28,"90th_percentile":14965.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 7 Musculoskeletal Procedures","code_information":[{"code":"5117","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":23702.75,"10th_percentile":23702.75,"90th_percentile":23702.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":9975.97,"10th_percentile":9975.97,"90th_percentile":9975.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":25633.73,"10th_percentile":25633.73,"90th_percentile":25633.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":23743.59,"10th_percentile":23743.59,"90th_percentile":23743.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":13852.37,"10th_percentile":13852.37,"90th_percentile":13852.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":19794.24,"10th_percentile":19794.24,"90th_percentile":19794.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":23162.92,"10th_percentile":23162.92,"90th_percentile":23255.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":3198.45,"10th_percentile":3198.45,"90th_percentile":3198.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":23726.22,"10th_percentile":23726.22,"90th_percentile":23726.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":23980.71,"10th_percentile":23980.71,"90th_percentile":23980.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":23447.97,"10th_percentile":23447.97,"90th_percentile":23447.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":461.4,"10th_percentile":461.4,"90th_percentile":461.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":550.63,"10th_percentile":550.63,"90th_percentile":550.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":556.64,"10th_percentile":556.64,"90th_percentile":556.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":541.85,"10th_percentile":541.85,"90th_percentile":541.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1340.39,"10th_percentile":1340.39,"90th_percentile":1340.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1383.53,"10th_percentile":1383.53,"90th_percentile":1383.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2348.92,"10th_percentile":2348.92,"90th_percentile":2348.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2803.25,"10th_percentile":2803.25,"90th_percentile":2803.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":874.0,"10th_percentile":874.0,"90th_percentile":874.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":780.61,"10th_percentile":780.61,"90th_percentile":780.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":538.23,"10th_percentile":538.23,"90th_percentile":538.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":922.03,"10th_percentile":922.03,"90th_percentile":922.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":362.0,"10th_percentile":362.0,"90th_percentile":362.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1139.31,"10th_percentile":1139.31,"90th_percentile":1139.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1270.78,"10th_percentile":1270.78,"90th_percentile":1270.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":3580.03,"10th_percentile":3580.03,"90th_percentile":3580.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":4532.93,"10th_percentile":4532.93,"90th_percentile":4532.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":3024.45,"10th_percentile":3024.45,"90th_percentile":3024.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":4428.95,"10th_percentile":4428.95,"90th_percentile":4428.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2372.82,"10th_percentile":2372.82,"90th_percentile":2372.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1746.79,"10th_percentile":1746.79,"90th_percentile":1746.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1452.27,"10th_percentile":1452.27,"90th_percentile":1452.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":2687.86,"10th_percentile":2107.03,"90th_percentile":2687.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1741.09,"10th_percentile":1741.09,"90th_percentile":1741.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1744.49,"10th_percentile":1744.49,"90th_percentile":1744.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":2881.43,"10th_percentile":2881.43,"90th_percentile":2881.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":1838.0,"10th_percentile":1838.0,"90th_percentile":1838.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1702.11,"10th_percentile":1702.11,"90th_percentile":1702.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":2851.5,"10th_percentile":2851.5,"90th_percentile":2851.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1745.89,"10th_percentile":1669.6,"90th_percentile":1941.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Procedures","code_information":[{"code":"5432","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1774.68,"10th_percentile":1774.68,"90th_percentile":1774.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":885.0,"10th_percentile":885.0,"90th_percentile":885.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"41","median_amount":267.56,"10th_percentile":261.98,"90th_percentile":277.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"24","median_amount":228.28,"10th_percentile":220.3,"90th_percentile":405.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"59","median_amount":1146.53,"10th_percentile":965.8,"90th_percentile":1180.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"45","median_amount":264.8,"10th_percentile":261.92,"90th_percentile":414.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":1338.27,"10th_percentile":892.18,"90th_percentile":1338.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"13","median_amount":267.56,"10th_percentile":265.9,"90th_percentile":277.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"88","median_amount":248.7,"10th_percentile":237.09,"90th_percentile":358.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"28","median_amount":656.0,"10th_percentile":656.0,"90th_percentile":656.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":266.24,"10th_percentile":266.24,"90th_percentile":267.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":267.45,"10th_percentile":267.45,"90th_percentile":267.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":271.13,"10th_percentile":271.13,"90th_percentile":271.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"66","median_amount":267.56,"10th_percentile":267.56,"90th_percentile":277.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":22.92,"10th_percentile":22.92,"90th_percentile":22.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":266.24,"10th_percentile":266.24,"90th_percentile":276.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"13","median_amount":566.0,"10th_percentile":566.0,"90th_percentile":566.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"117","median_amount":266.24,"10th_percentile":261.99,"90th_percentile":277.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":272.35,"10th_percentile":272.35,"90th_percentile":272.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":273.35,"10th_percentile":264.07,"90th_percentile":276.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":885.0,"10th_percentile":885.0,"90th_percentile":885.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"39","median_amount":609.43,"10th_percentile":600.03,"90th_percentile":643.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"11","median_amount":524.97,"10th_percentile":524.97,"90th_percentile":536.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"31","median_amount":1146.53,"10th_percentile":1146.53,"90th_percentile":1180.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"38","median_amount":618.67,"10th_percentile":600.03,"90th_percentile":637.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":892.18,"10th_percentile":892.18,"90th_percentile":892.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":640.73,"10th_percentile":19.2,"90th_percentile":640.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"51","median_amount":843.17,"10th_percentile":843.17,"90th_percentile":884.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"13","median_amount":1384.1,"10th_percentile":1379.81,"90th_percentile":1441.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":643.01,"10th_percentile":633.72,"90th_percentile":643.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":624.55,"10th_percentile":624.55,"90th_percentile":624.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"14","median_amount":615.29,"10th_percentile":615.29,"90th_percentile":648.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":643.94,"10th_percentile":633.51,"90th_percentile":644.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":793.0,"10th_percentile":793.0,"90th_percentile":793.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"75","median_amount":618.68,"10th_percentile":601.04,"90th_percentile":638.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":607.33,"10th_percentile":607.33,"90th_percentile":607.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":641.66,"10th_percentile":641.66,"90th_percentile":641.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"14","median_amount":885.0,"10th_percentile":885.0,"90th_percentile":984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"68","median_amount":819.18,"10th_percentile":754.91,"90th_percentile":1214.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"13","median_amount":683.61,"10th_percentile":664.41,"90th_percentile":1015.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"94","median_amount":1338.27,"10th_percentile":1146.53,"90th_percentile":1719.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"61","median_amount":813.64,"10th_percentile":751.84,"90th_percentile":1209.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":1561.32,"10th_percentile":1561.32,"90th_percentile":1561.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"14","median_amount":1139.61,"10th_percentile":761.84,"90th_percentile":1213.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"150","median_amount":1139.06,"10th_percentile":843.17,"90th_percentile":1326.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"32","median_amount":656.0,"10th_percentile":656.0,"90th_percentile":984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":759.34,"10th_percentile":758.62,"90th_percentile":1140.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":1163.78,"10th_percentile":1163.78,"90th_percentile":1163.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":793.0,"10th_percentile":793.0,"90th_percentile":793.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"47","median_amount":1156.44,"10th_percentile":770.96,"90th_percentile":1232.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":747.31,"10th_percentile":747.31,"90th_percentile":747.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"12","median_amount":820.48,"10th_percentile":760.74,"90th_percentile":1214.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"26","median_amount":1189.5,"10th_percentile":793.0,"90th_percentile":1189.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"122","median_amount":1128.76,"10th_percentile":760.94,"90th_percentile":1213.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1135.05,"10th_percentile":1135.05,"90th_percentile":1215.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":757.84,"10th_percentile":18.74,"90th_percentile":817.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2566.46,"10th_percentile":2566.46,"90th_percentile":2566.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":3261.13,"10th_percentile":3261.13,"90th_percentile":3261.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":3139.37,"10th_percentile":3139.37,"90th_percentile":3139.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":2993.76,"10th_percentile":2993.76,"90th_percentile":2993.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":45832.97,"10th_percentile":45832.97,"90th_percentile":45832.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":21356.53,"10th_percentile":21356.53,"90th_percentile":21356.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":26230.29,"10th_percentile":26230.29,"90th_percentile":26230.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"14","median_amount":1078.26,"10th_percentile":69.99,"90th_percentile":11182.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":78.74,"10th_percentile":75.86,"90th_percentile":80.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"11","median_amount":65.71,"10th_percentile":64.72,"90th_percentile":220.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":119.17,"10th_percentile":29.49,"90th_percentile":184.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":78.42,"10th_percentile":78.42,"90th_percentile":147.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":186.26,"10th_percentile":186.26,"90th_percentile":186.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":74.64,"10th_percentile":74.64,"90th_percentile":78.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"28","median_amount":108.32,"10th_percentile":63.56,"90th_percentile":128.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":426.8,"10th_percentile":274.23,"90th_percentile":503.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":75.86,"10th_percentile":75.86,"90th_percentile":80.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":74.58,"10th_percentile":74.58,"90th_percentile":78.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":292.88,"10th_percentile":261.88,"90th_percentile":297.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"13","median_amount":74.88,"10th_percentile":74.48,"90th_percentile":78.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":74.27,"10th_percentile":74.27,"90th_percentile":74.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"17","median_amount":85.9,"10th_percentile":81.89,"90th_percentile":538.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"39","median_amount":95.09,"10th_percentile":89.23,"90th_percentile":114.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"35","median_amount":77.75,"10th_percentile":77.75,"90th_percentile":164.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"77","median_amount":269.37,"10th_percentile":111.77,"90th_percentile":308.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"18","median_amount":95.09,"10th_percentile":89.23,"90th_percentile":189.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":305.21,"10th_percentile":305.21,"90th_percentile":605.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"11","median_amount":96.61,"10th_percentile":94.71,"90th_percentile":201.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"125","median_amount":114.98,"10th_percentile":114.37,"90th_percentile":164.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":519.0,"10th_percentile":240.27,"90th_percentile":519.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":91.13,"10th_percentile":90.68,"90th_percentile":96.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":94.32,"10th_percentile":72.87,"90th_percentile":196.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":0.63,"10th_percentile":0.63,"90th_percentile":0.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"42","median_amount":96.64,"10th_percentile":91.13,"90th_percentile":96.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":216.93,"10th_percentile":216.93,"90th_percentile":216.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":96.64,"10th_percentile":90.68,"90th_percentile":369.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"18","median_amount":598.0,"10th_percentile":169.0,"90th_percentile":598.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"65","median_amount":94.71,"10th_percentile":89.23,"90th_percentile":114.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":94.91,"10th_percentile":94.91,"90th_percentile":94.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":90.68,"10th_percentile":90.68,"90th_percentile":90.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"29","median_amount":144.02,"10th_percentile":125.59,"90th_percentile":400.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"23","median_amount":206.96,"10th_percentile":203.65,"90th_percentile":297.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"27","median_amount":180.39,"10th_percentile":177.45,"90th_percentile":180.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"64","median_amount":598.38,"10th_percentile":590.81,"90th_percentile":1066.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"18","median_amount":216.17,"10th_percentile":203.65,"90th_percentile":357.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":674.85,"10th_percentile":627.61,"90th_percentile":1302.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":312.49,"10th_percentile":219.68,"90th_percentile":483.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"98","median_amount":263.28,"10th_percentile":250.99,"90th_percentile":323.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"16","median_amount":655.0,"10th_percentile":655.0,"90th_percentile":1174.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":207.9,"10th_percentile":207.9,"90th_percentile":207.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":6.44,"10th_percentile":6.44,"90th_percentile":6.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"52","median_amount":207.98,"10th_percentile":207.98,"90th_percentile":316.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":489.04,"10th_percentile":489.04,"90th_percentile":489.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":219.68,"10th_percentile":219.09,"90th_percentile":294.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"29","median_amount":793.0,"10th_percentile":793.0,"90th_percentile":1391.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"72","median_amount":215.29,"10th_percentile":203.65,"90th_percentile":449.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":219.29,"10th_percentile":219.29,"90th_percentile":542.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":296.95,"10th_percentile":296.95,"90th_percentile":296.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":106.25,"10th_percentile":106.25,"90th_percentile":106.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":563.38,"10th_percentile":563.38,"90th_percentile":563.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":498.3,"10th_percentile":498.3,"90th_percentile":498.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":358.82,"10th_percentile":358.82,"90th_percentile":1122.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":366.67,"10th_percentile":366.67,"90th_percentile":366.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":391.07,"10th_percentile":391.07,"90th_percentile":391.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":669.57,"10th_percentile":669.57,"90th_percentile":669.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":400.02,"10th_percentile":400.02,"90th_percentile":610.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":152.89,"10th_percentile":152.89,"90th_percentile":161.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":602.31,"10th_percentile":602.31,"90th_percentile":602.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":158.55,"10th_percentile":158.55,"90th_percentile":161.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":361.54,"10th_percentile":297.92,"90th_percentile":885.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":302.61,"10th_percentile":297.77,"90th_percentile":324.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":266.52,"10th_percentile":266.52,"90th_percentile":266.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"18","median_amount":1202.54,"10th_percentile":697.92,"90th_percentile":1941.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":319.37,"10th_percentile":297.56,"90th_percentile":414.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":1040.53,"10th_percentile":1040.53,"90th_percentile":1040.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":319.97,"10th_percentile":319.97,"90th_percentile":324.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"17","median_amount":461.37,"10th_percentile":326.73,"90th_percentile":774.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":550.84,"10th_percentile":550.84,"90th_percentile":550.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":300.56,"10th_percentile":300.56,"90th_percentile":300.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"13","median_amount":304.1,"10th_percentile":304.1,"90th_percentile":324.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":1269.87,"10th_percentile":1269.87,"90th_percentile":1269.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":323.07,"10th_percentile":323.07,"90th_percentile":323.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"11","median_amount":319.37,"10th_percentile":298.98,"90th_percentile":580.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":302.45,"10th_percentile":302.45,"90th_percentile":302.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1047.72,"10th_percentile":1047.72,"90th_percentile":1047.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":856.12,"10th_percentile":856.12,"90th_percentile":856.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":1146.53,"10th_percentile":1146.53,"90th_percentile":1146.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1023.02,"10th_percentile":1021.72,"90th_percentile":1023.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"1 through 10","median_amount":892.18,"10th_percentile":892.18,"90th_percentile":892.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1023.65,"10th_percentile":1023.65,"90th_percentile":1023.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"11","median_amount":733.66,"10th_percentile":733.66,"90th_percentile":769.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":1291.0,"10th_percentile":1291.0,"90th_percentile":1291.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":987.41,"10th_percentile":987.41,"90th_percentile":987.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1025.02,"10th_percentile":1025.02,"90th_percentile":1025.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"11","median_amount":1023.02,"10th_percentile":988.64,"90th_percentile":1093.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":152.62,"10th_percentile":152.62,"90th_percentile":152.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":304.7,"10th_percentile":304.7,"90th_percentile":304.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":312.44,"10th_percentile":312.44,"90th_percentile":312.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1828.63,"10th_percentile":1828.63,"90th_percentile":1828.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":711.98,"10th_percentile":711.98,"90th_percentile":711.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":1013.62,"10th_percentile":1013.62,"90th_percentile":1013.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":874.01,"10th_percentile":874.01,"90th_percentile":874.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":874.0,"10th_percentile":874.0,"90th_percentile":874.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":313.27,"10th_percentile":313.27,"90th_percentile":313.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":226.22,"10th_percentile":226.22,"90th_percentile":226.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":281.47,"10th_percentile":281.47,"90th_percentile":281.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":528.04,"10th_percentile":520.99,"90th_percentile":528.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":530.26,"10th_percentile":505.52,"90th_percentile":530.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":315.0,"10th_percentile":315.0,"90th_percentile":315.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":482.0,"10th_percentile":482.0,"90th_percentile":493.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":21.5,"10th_percentile":21.5,"90th_percentile":21.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":32.8,"10th_percentile":32.8,"90th_percentile":40.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":51.17,"10th_percentile":50.35,"90th_percentile":53.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"26","median_amount":44.33,"10th_percentile":43.87,"90th_percentile":44.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"33","median_amount":95.11,"10th_percentile":71.91,"90th_percentile":108.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":50.15,"10th_percentile":50.15,"90th_percentile":52.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":50.39,"10th_percentile":50.39,"90th_percentile":50.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"50","median_amount":44.49,"10th_percentile":41.65,"90th_percentile":48.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":190.71,"10th_percentile":151.32,"90th_percentile":232.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":51.17,"10th_percentile":51.17,"90th_percentile":51.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"55","median_amount":51.42,"10th_percentile":51.42,"90th_percentile":53.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":66.55,"10th_percentile":56.23,"90th_percentile":68.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":53.81,"10th_percentile":53.31,"90th_percentile":53.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"13","median_amount":181.8,"10th_percentile":180.4,"90th_percentile":186.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"31","median_amount":51.15,"10th_percentile":50.36,"90th_percentile":53.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":53.1,"10th_percentile":53.1,"90th_percentile":53.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":49.41,"10th_percentile":49.41,"90th_percentile":49.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":114.8,"10th_percentile":114.8,"90th_percentile":114.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":96.19,"10th_percentile":96.19,"90th_percentile":96.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"1 through 10","median_amount":95.11,"10th_percentile":88.2,"90th_percentile":95.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":113.09,"10th_percentile":113.09,"90th_percentile":113.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":114.8,"10th_percentile":114.8,"90th_percentile":114.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":23.39,"10th_percentile":16.32,"90th_percentile":246.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":310.0,"10th_percentile":310.0,"90th_percentile":310.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"14","median_amount":115.97,"10th_percentile":115.97,"90th_percentile":117.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":32.96,"10th_percentile":32.96,"90th_percentile":191.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":114.8,"10th_percentile":113.1,"90th_percentile":114.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":113.1,"10th_percentile":113.1,"90th_percentile":113.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"1 through 10","median_amount":874.0,"10th_percentile":874.0,"90th_percentile":874.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":575.3,"10th_percentile":575.3,"90th_percentile":575.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red blood cells unit","code_information":[{"code":"9517","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":1897.02,"10th_percentile":1897.02,"90th_percentile":1897.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":111.5,"10th_percentile":111.5,"90th_percentile":111.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"22","median_amount":55.3,"10th_percentile":24.67,"90th_percentile":250.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"31","median_amount":30.59,"10th_percentile":19.3,"90th_percentile":66.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"17","median_amount":29.26,"10th_percentile":18.4,"90th_percentile":71.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"24","median_amount":23.2,"10th_percentile":13.56,"90th_percentile":23.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":27.11,"10th_percentile":27.11,"90th_percentile":30.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"17","median_amount":19.51,"10th_percentile":15.41,"90th_percentile":30.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"73","median_amount":19.52,"10th_percentile":10.01,"90th_percentile":38.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"1 through 10","median_amount":131.04,"10th_percentile":58.97,"90th_percentile":173.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":18.33,"10th_percentile":18.33,"90th_percentile":30.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":31.14,"10th_percentile":29.01,"90th_percentile":46.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"1 through 10","median_amount":286.24,"10th_percentile":286.24,"90th_percentile":286.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"45","median_amount":27.67,"10th_percentile":16.86,"90th_percentile":55.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"1 through 10","median_amount":35.01,"10th_percentile":35.01,"90th_percentile":35.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"41","median_amount":19.26,"10th_percentile":16.53,"90th_percentile":38.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"1 through 10","median_amount":14.06,"10th_percentile":5.89,"90th_percentile":51.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"128","median_amount":19.51,"10th_percentile":19.26,"90th_percentile":40.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":26.87,"10th_percentile":26.87,"90th_percentile":26.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":19.5,"10th_percentile":19.26,"90th_percentile":23.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":6.0,"10th_percentile":6.0,"90th_percentile":6.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2639] [Arthroscopy ($): 3046] [Cardiac Cath ($): 5616] [Hip Replacement ($): 7778] [Knee Replacement ($): 8007] [Observation ($): 1373] [ED Level 1--99281 ($): 407] [ED Level 2--99282 ($): 407] [ED Level 3--99283 ($): 594] [ED Level 4--99284 ($): 874] [ED Level 5--99285 ($): 1123] [OP High Cost Drugs (%BC): 32.86 Charge Threshold: 500] [Other Outpatient Implant (%BC): 32.86 Charge Threshold: 500] [All Other OP (%BC): 52]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"1 through 10","median_amount":56.81,"10th_percentile":56.81,"90th_percentile":56.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 1435] [ED Level 1--99281 ($): 280.45] [ED Level 2--99282 ($): 711.98] [ED Level 3--99283 ($): 2089.25] [Radiology Fee Schedule: Fee Schedule] [Laboratory Fee Schedule: Fee Schedule] [Occupational Therapy ($): 149.59] [Physical Therapy ($): 149.59] [Speech Therapy ($): 149.59] [Other Outpatient Implant (%BC): 50 Charge Threshold: 750] [All Other OP (%BC): 47 Maximum Reimbursement: 1435]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Ungroupable (%BC): 47 Maximum Reimbursement: 2424.41] [ED Level 1--99281 ($): 212.13] [ED Level 2--99282 ($): 538.23] [ED Level 3--99283 ($): 1578.28] [Occupational Therapy ($): 112.75] [Physical Therapy ($): 112.75] [Speech Therapy ($): 112.75] [Other Outpatient Implant (%BC): 36.67 Charge Threshold: 1000] [All Other OP (%BC): 47 Maximum Reimbursement: 2424.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[EAPG-Significant Procedure/Medical Visit ($): 617.88] [EAPG-Ancillary ($): 617.88]","count":"1 through 10","median_amount":117.03,"10th_percentile":117.03,"90th_percentile":117.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Fetal Non-Stress Test ($): 226] [Amniocentesis (%BC): 39 Maximum Reimbursement: 800] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 79 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 2037] [Cardiac Cath ($): 2783] [Laminectomy/Diskectomy ($): 3652] [Lap Chole ($): 3371] [PTCA ($): 5250] [Observation (%BC): 39 Maximum Reimbursement: 1600] [ED Level 1--99281 ($): 152] [ED Level 2--99282 ($): 152] [ED Level 3--99283 ($): 362] [ED Level 4--99284 ($): 788] [ED Level 5--99285 ($): 788] [Critical Care ($): 1523] [Urgent Care ($): 263] [Chemotherapy ($): 315] [Nuclear Medicine ($): 312] [Radiation Therapy  (%BC): 39 Maximum Reimbursement: 800] [CT Scan OP ($): 519] [MRI OP ($): 655] [Positron Emission Tomography ($): 1208] [Radiology (%BC): 39 Maximum Reimbursement: 800] [Laboratory (%BC): 39 Maximum Reimbursement: 800] [Hemodialysis ($): 331] [Peritoneal Dialysis, CAPD, and CCPD ($): 331] [Occupational Therapy ($): 79] [Physical Therapy ($): 79] [Resp. Services/Therapy ($): 79] [Speech Therapy ($): 79] [OP High Cost Drugs (%BC): 49 Charge Threshold: 1000] [Other Outpatient Implant (%BC): 49 Charge Threshold: 1000] [All Other OP (%BC): 39 Maximum Reimbursement: 800]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All OP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [Outpatient Services: Blood and Blood Related Services ($): 306] [Cyber Knife-Initial Visit ($): 383] [Cyber Knife-Subsequent Visit ($): 218] [Audiology ($): 71] [Labor Room/Delivery Services ($): 236] [Other Diagnostic Services ($): 119] [Allergy Testing ($): 77] [Other Therapeutic Service ($): 58] [Education and Training ($): 84] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 829] [Stereotactic Radiosurgery ($): 492] [Observation ($): 829] [ED Level 1--99281 ($): 82] [ED Level 2--99282 ($): 142] [ED Level 3--99283 ($): 223] [ED Level 4--99284 ($): 359] [ED Level 5--99285 ($): 530] [Critical Care ($): 1204] [Urgent Care ($): 89] [Cardiac Rehabilitation Therapy ($): 119] [Cardiac Stress Test ($): 119] [Cardiology ($): 947] [Echocardiology ($): 119] [EKG/ECG ($): 176] [Holter Monitor/Telemetry ($): 95] [Peripheral Vascular Lab ($): 176] [EEG ($): 176] [EMG ($): 119] [MEG ($): 437] [Neuropsychological Testing and Biofeedback ($): 71] [Sleep Studies-Attended ($): 609] [Sleep Studies-Unattended ($): 199] [Chemotherapy ($): 409] [Nuclear Medicine ($): 473] [Oncology ($): 176] [Radiation Therapy ($): 356] [CT Scan OP ($): 625] [MRI OP ($): 829] [Imaging Services ($): 119] [Mammography-Diagnostic ($): 53] [Mammography-Screening ($): 53] [Positron Emission Tomography ($): 1301] [Radiology ($): 95] [Ultrasound Imaging ($): 119] [Laboratory Fee Schedule: Fee Schedule] [Hemodialysis ($): 356] [Peritoneal Dialysis, CAPD, and CCPD ($): 151] [Occupational Therapy ($): 71] [Physical Therapy ($): 71] [Resp. Services/Therapy ($): 58] [Speech Therapy ($): 71] [Other Outpatient Implant-Cost: 100 Charge Threshold: 2500] [Ambulance--Air ($): 273] [Ambulance--Land ($): 928] [Hyperbarics ($): 176] [IV Therapy ($): 131] [Pulmonary Function ($): 100] [Pulmonary Rehabilitation ($): 73]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [APC ($): 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Exchange","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 80000 | Threshold Total (% BC): 45] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 3094.13] [Surgical-Per Diem: 3094.13] [ICU-Per Diem: 3636.29] [CCU-Per Diem: 3636.29] [Rehab-Per Diem: 1302.48] [SNF-Per Diem: 757.16] [IP Prosthetics/Implants/Devices (%BC): 50 Charge Threshold: 750] [Cardiac Cath-Per Diem: 3404.17]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Anthem PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 10000 | Threshold Total (% BC): 55] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule] [Medical-Per Diem: 2424.41] [Surgical-Per Diem: 2424.41] [ICU-Per Diem: 2644.81] [CCU-Per Diem: 2644.81] [SNF-Per Diem: 546.59] [IP Prosthetics/Implants/Devices (%BC): 36.67 Charge Threshold: 1000]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Blue Cross","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Inpatient Services: MSDRG Group 1-Per Diem: 2293] [MSDRG Group 2-Per Diem: 3048] [MSDRG Group 3-Per Diem: 4093] [MSDRG Group 4-Per Diem: 5091] [MSDRG Group 5-Per Diem: 6855] [MSDRG Group 6-Per Diem: 11426] [Hip Replacement-Case Rate: 18975] [Alcohol/ Chemical Dependency-Per Diem: 850] [Psych-Per Diem: 850]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Charge Threshold: 82800 | Threshold Excess Per Diem: 1275] [Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: Fee Schedule Days: Various Additional Days: 1733] [Medical-Per Diem: 1916] [Surgical-Per Diem: 1916] [ICU-Per Diem: 2310] [CCU-Per Diem: 2310] [Step Down-Per Diem: 2100] [C-Section-Case Rate: 3885] [Normal Vaginal Delivery-Case Rate: 3045] [Normal Newborn-Per Diem: 315] [Nursery  Level 1- Boarder-Per Diem: 315] [Nursery  Level 2-Per Diem: 1339] [Nursery  Level 3-Per Diem: 1733] [Nursery  Level 4-NICU-Per Diem: 1943] [Alcohol/ Chemical Dependency-Per Diem: 683] [Rehab-Per Diem: 971] [Hospice-Per Diem: 578] [IP High Cost Drugs-Cost: 49 Charge Threshold: 3090] [IP Prosthetics/Implants/Devices-Cost: 49 Charge Threshold: 3090]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 102% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Optum","plan_name":"VA CCN Government","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [All IP services (% of Medicaid): 100]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100.00] [MSDRG Base Rate: 100% of Medicare]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Days Threshold: AMLOS + 6 days | Threshold Excess Per Diem: 3290] [Lesser Than Charges paid at %: 100.00] [Inpatient Services: One Day Stay-Case Rate: 1093] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 4869] [Normal Vaginal Delivery-Case Rate: 3654] [Normal Newborn-Per Diem: 366] [Lower Level Neonate-Per Diem: 366] [Higher Level Neonate-Per Diem: 366] [Severe Level Neonate-per diem: 366] [Rehab-Per Diem: 426] [SNF-Per Diem: 366] [Hospice-Per Diem: 548]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care 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treatment","code_information":[{"code":"94640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.87,"maximum":194.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.69,"additional_payer_notes":"APC"}]}]},{"description":"Aerosol inhalation treatment","code_information":[{"code":"94642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.87,"maximum":194.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.69,"additional_payer_notes":"APC"}]}]},{"description":"Pos airway pressure cpap","code_information":[{"code":"94660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.87,"maximum":194.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.69,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate pt use of inhaler","code_information":[{"code":"94664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.87,"maximum":194.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.69,"additional_payer_notes":"APC"}]}]},{"description":"Mechanical chest wall oscill","code_information":[{"code":"94669","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.87,"maximum":194.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":190.87,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":194.69,"additional_payer_notes":"APC"}]}]},{"description":"Red blood cells unit","code_information":[{"code":"P9021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":150.57,"maximum":153.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":150.57,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":153.58,"additional_payer_notes":"APC"}]}]},{"description":"Cntct lens hydrophil photoch","code_information":[{"code":"V2524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":154.45,"maximum":157.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":154.45,"additional_payer_notes":"APC"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":157.54,"additional_payer_notes":"APC"}]}]}],"modifier_information":[{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Distinct Procedural Service","code":"59","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reference (Outside) Laboratory","code":"90","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Special acquisition of blood and blood products","code":"BL","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, fifth digit","code":"T9","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit","code":"GY","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, great toe","code":"T5","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional","code":"76","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the same day of the Procedure or Other Service","code":"25","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, great toe","code":"TA","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, third digit","code":"F2","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, second digit","code":"F1","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, fourth digit","code":"F3","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, fifth digit","code":"F4","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, thumb","code":"F5","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, second digit","code":"F6","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, third digit","code":"F7","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, fourth digit","code":"F8","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right hand, fifth digit","code":"F9","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, second digit","code":"T1","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, third digit","code":"T2","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, fourth digit","code":"T3","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left foot, fifth digit","code":"T4","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, second digit","code":"T6","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, thumb","code":"FA","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, third digit","code":"T7","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right foot, fourth digit","code":"T8","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"Peach State Health Plan","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ambetter Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Blue Cross","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Clover Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"HealthSpring","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Gold Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optum","plan_name":"VA CCN Government","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"AARP Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"VIVA HEALTH","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}]}